OBJECTIVE The objective of the article is to analyze the effects of the end-effector technology for gait rehabilitation on acute, subacute, and chronic stroke in order to verify the efficacy of the treatment in older people, based on evidence from randomized controlled trials, and thus increase the clinical knowledge for future applications in the hospital setting. DESIGN A systematic review of the literature was conducted in October 2018. The data were collected from Cochrane, Embase, Scopus, and PubMed databases, analyzing manuscripts and articles of the last 10 years. SETTING We included only randomized controlled trials written in English and aimed to study the effects of end-effector devices in improving walking in stroke patients. We selected 20 studies, and the results were divided into subacute stroke patients and chronic stroke patients. MEASURES Quality evaluation was performed using the PEDro scale. Of the 10 studies considered, 9 were randomized controlled trials. The PEDro scale score ranged from 7 to 10. RESULTS Robotic-assisted gait trainer is more effective for subacute stroke patients with a lower function ambulation assessment, showing significant changes in independent walking ability. One possible explanation of the improvement of the gait speed and functional ambulation is the opportunity of receiving a more intensive and repetitive task-oriented training through end-effector robotic-based intervention. CONCLUSIONS AND IMPLICATIONS The use of robotic-assisted gait trainer, together with a conventional treatment, seems to improve the walking capability of patients. Future research trials should take into account the impact of the robotic end-effector gait training on the oldest population, as this target was only partially included in the studies examined. Availability of new evidence will support the design of innovative assistive models for the clinical rehabilitation setting, which will take into account the need of personalizing the intervention to support the growing oldest old population.

中文翻译：

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基于末端效应步态训练器对老年卒中患者的干预效果：系统评价

目的 本文的目的是基于随机对照试验的证据，分析用于步态康复的末端执行器技术对急性、亚急性和慢性卒中的影响，以验证治疗对老年人的疗效，以及从而增加未来在医院环境中应用的临床知识。设计 2018 年 10 月对文献进行了系统回顾。数据来自 Cochrane、Embase、Scopus 和 PubMed 数据库，分析了过去 10 年的手稿和文章。设置 我们仅纳入了用英语编写的随机对照试验，旨在研究末端执行器装置在改善中风患者步行方面的效果。我们选取了 20 项研究，将结果分为亚急性脑卒中患者和慢性脑卒中患者。措施 使用PEDro 量表进行质量评估。在考虑的 10 项研究中，9 项是随机对照试验。PEDro 量表评分范围为 7 至 10。 结果机器人辅助步态训练器对步行功能评估较低的亚急性中风患者更有效，显示独立行走能力发生显着变化。步态速度和功能性行走改善的一种可能解释是，通过基于末端执行器的机器人干预，有机会接受更密集和重复的面向任务的训练。结论和意义 使用机器人辅助步态训练器，结合常规治疗，似乎可以提高患者的步行能力。未来的研究试验应考虑机器人末端执行器步态训练对最年长人群的影响，因为该目标仅部分包含在所审查的研究中。新证据的可用性将支持为临床康复环境设计创新的辅助模型，这将考虑个性化干预以支持不断增长的老年人口的需要。