{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T15:16:56Z","timestamp":1772119016908,"version":"3.50.1"},"reference-count":59,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T00:00:00Z","timestamp":1772064000000},"content-version":"unspecified","delay-in-days":25,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"HKMU Research Matching Grant","award":["2021\/2001"],"award-info":[{"award-number":["2021\/2001"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,2,4]]},"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Individuals with incomplete spinal cord injury (iSCI) often experience impaired balance control and turning-while-walking ability, which increase the risk of falls and limit their community mobility. While overground exoskeleton training has shown promise in improving gait and balance, evidence from randomised controlled trials (RCTs) on ambulation of individuals with iSCI remains limited. This protocol outlines a cluster RCT investigating the effectiveness of overground exoskeleton-assisted gait training compared with conventional training and usual care in improving turning-while-walking performence, balance control, and functional mobility in individuals with iSCI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This multicentre, cluster RCT will compare 12-week interventions across three groups: (1) overground exoskeleton training group, (2) conventional training group and (3) usual care group. Participants with ambulatory iSCI will be recruited from three centres in Hong Kong SAR and mainland China. Primary outcomes include turning duration and number of steps during a 2-m turning-while-walking test. Secondary outcomes include static and dynamic balance, sensorimotor integration, gait performance, muscle strength, spasticity, quality of life, self-efficacy and fall incidence. Assessments will be conducted at baseline, mid-intervention, postintervention and at the 1-month follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This study has received approval from the Research Ethics Committees of Hong Kong Metropolitan University, the Affiliated BenQ Hospital of Nanjing Medical University, and Changzhou Sunshine Rehabilitation Hospital. Written informed consent will be obtained from all participants before enrolment. Study findings will be shared through peer-reviewed publications, conference presentations and summaries available to participants upon request.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT06971510\">NCT06971510<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-112405","type":"journal-article","created":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T14:15:21Z","timestamp":1772115321000},"page":"e112405","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness of exoskeleton training on turning-while-walking and balance control in subjects with incomplete spinal cord injury: protocol for a randomised clinical trial"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct06971510","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6584-2095","authenticated-orcid":false,"given":"Ming","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Physiotherapy, School of Nursing and Health Sciences, Hong Kong Metropolitan University, Hong Kong, China"},{"name":"Department of Rehabilitation Medicine, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chad Wing-nga","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, School of Nursing and Health Sciences, Hong Kong Metropolitan University, Hong Kong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter Yan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William Wai-nam","family":"Tsang","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, School of Nursing and Health Sciences, Hong Kong Metropolitan University, Hong Kong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,2,26]]},"reference":[{"key":"2026022606151272000_16.2.e112405.1","doi-asserted-by":"crossref","DOI":"10.3390\/ijms21207533","article-title":"Spinal Cord Injury: Pathophysiology, Multimolecular Interactions, and Underlying Recovery Mechanisms","volume":"21","author":"Anjum","year":"2020","journal-title":"Int J Mol Sci"},{"key":"2026022606151272000_16.2.e112405.2","doi-asserted-by":"crossref","first-page":"1489","DOI":"10.4103\/1673-5374.330603","article-title":"Targeting the motor cortex to restore walking after incomplete spinal cord injury","volume":"17","author":"Martinez","year":"2022","journal-title":"Neural Regen Res"},{"key":"2026022606151272000_16.2.e112405.3","doi-asserted-by":"crossref","first-page":"1666","DOI":"10.1016\/j.spinee.2020.05.551","article-title":"The effect of age and injury severity on clinical prediction rules for ambulation among individuals with spinal cord injury","volume":"20","author":"Engel-Haber","year":"2020","journal-title":"Spine J"},{"key":"2026022606151272000_16.2.e112405.4","doi-asserted-by":"crossref","unstructured":"Ogawa A , Takeda T , Yoshino K , et al . 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