Abstract
Objective
To describe systematic reviews (SRs) of the use of exoskeletons for gait and mobility by persons with neurological disorders and to evaluate their quality as guidance for research and clinical practice.
Data sources
PubMed, EMBASE, Web of Science, CINAHL Complete, PsycINFO, Cochrane Database of Systematic Reviews, PEDro, and Google Scholar were searched from database inception to January 23, 2018.
Study selection
A total of 331 de-duplicated abstracts from bibliographic database and ancestor searching were independently screened by two reviewers, resulting in 109 articles for which full text was obtained. Independent screening of those 109 articles by two reviewers resulted in a final selection of 17 SRs.
Data extraction
Data were extracted by one reviewer using a pretested Excel form with 158 fields and checked by a second reviewer. Key data included the purpose of the SR, methods used, outcome measures presented, and conclusions. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 were used to evaluate reporting and methodological quality, respectively, of the SRs.
Data synthesis
The SRs generally were of poor methodological and reporting quality. They failed to report some information on patients (e.g. height, weight, baseline ambulatory status) and interventions (e.g. treatment hours/sessions planned and delivered) that clinicians and other stakeholders might want to have, and often failed to notice that the primary studies duplicated subjects.
Conclusions
Published SRs on exoskeletons have many weaknesses in design and execution; clinicians, researchers, and other stakeholders should be cautious in relying on them to make decisions on the use of this technology. Future studies need to address the multiple methodological limitations.
TBI Rehabilitation 