{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T03:08:25Z","timestamp":1773198505943,"version":"3.50.1"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T00:00:00Z","timestamp":1773100800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurosci."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Spinal cord injury affects approximately 9 million people worldwide, with incomplete injuries representing the majority of cases and offering greater potential for functional recovery. Overground robotic exoskeletons have emerged as promising rehabilitation tools, yet evidence regarding their effectiveness specifically during early inpatient rehabilitation remains inadequately synthesised.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To systematically evaluate the effectiveness of overground robotic exoskeletons compared to conventional rehabilitation for improving walking function in adults with incomplete spinal cord injury during early inpatient rehabilitation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This protocol follows PRISMA-P guidelines. Searches will be conducted across MEDLINE, Embase, CINAHL, Cochrane Library, and PEDro from inception through December 2025. Randomised and non-randomised controlled trials will be included. Two reviewers will independently screen studies using Covidence, extract data, and assess risk of bias using RoB 2 and ROBINS-I tools. Meta-analysis will be conducted where appropriate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This protocol establishes a rigorous framework for synthesising evidence on early exoskeleton-assisted rehabilitation, addressing a critical gap in clinical practice guidelines for spinal cord injury rehabilitation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnins.2026.1781656","type":"journal-article","created":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T06:43:41Z","timestamp":1773125021000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness of overground robotic exoskeletons in early inpatient rehabilitation for incomplete spinal cord injury: a systematic review protocol"],"prefix":"10.3389","volume":"20","author":[{"given":"Ravi","family":"Shankar","sequence":"first","affiliation":[{"name":"Clinical Research & Innovation Office, Tan Tock Seng Hospital, National Healthcare Group","place":["Singapore, Singapore"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nur","family":"Shafawati","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Alexandra Hospital, National University Health System","place":["Singapore, Singapore"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gobinathan","family":"Chandran","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Alexandra Hospital, National University Health System","place":["Singapore, Singapore"]},{"name":"Division of Rehabilitation Medicine, Department of Medicine, National University Hospital, National University Health System","place":["Singapore, Singapore"]},{"name":"Yong Loo Lin School of Medicine, National University of Singapore","place":["Singapore, Singapore"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,10]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1371","DOI":"10.1089\/neu.2004.21.1371","article-title":"Targeting recovery: priorities of the spinal cord-injured population","volume":"21","author":"Anderson","year":"2004","journal-title":"J. Neurotrauma"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1177\/1545968310376756","article-title":"The reproducibility and convergent validity of the walking index for spinal cord injury (WISCI) in chronic spinal cord injury","volume":"25","author":"Burns","year":"2011","journal-title":"Neurorehabil. Neural Repair"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"l6890","DOI":"10.1136\/bmj.l6890","article-title":"Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline","volume":"368","author":"Campbell","year":"2020","journal-title":"BMJ"},{"key":"ref4","volume-title":"Cochrane Handbook for systematic Reviews of Interventions","author":"Chandler","year":"2019"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1119","DOI":"10.1177\/02692155231164092","article-title":"A systematic review of the determinants of implementation of a locomotor training program using a powered exoskeleton for individuals with a spinal cord injury","volume":"37","author":"Charette","year":"2023","journal-title":"Clin. Rehabil."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1532","DOI":"10.1097\/brs.0000000000004417","article-title":"Spinal cord injury: the global incidence, prevalence, and disability from the global burden of disease study 2019","volume":"47","author":"Ding","year":"2022","journal-title":"Spine (Phila Pa 1976)"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1177\/0888439003255508","article-title":"Methods for a randomized trial of weight-supported treadmill training versus conventional training for walking during inpatient rehabilitation after incomplete traumatic spinal cord injury","volume":"17","author":"Dobkin","year":"2003","journal-title":"Neurorehabil. Neural Repair"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1136\/bmj.315.7109.629","article-title":"Bias in meta-analysis detected by a simple, graphical test","volume":"315","author":"Egger","year":"1997","journal-title":"BMJ"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1186\/s13643-025-02974-1","article-title":"Effects of an exoskeleton robot on motor function in patients with spinal cord injuries: a systematic review and meta-analysis","volume":"14","author":"Guo","year":"2025","journal-title":"Syst. Rev."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"924","DOI":"10.1136\/bmj.39489.470347.AD","article-title":"GRADE: an emerging consensus on rating quality of evidence and strength of recommendations","volume":"336","author":"Guyatt","year":"2008","journal-title":"BMJ"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1016\/j.wneu.2024.01.167","article-title":"Exoskeleton-assisted rehabilitation and neuroplasticity in spinal cord injury","volume":"185","author":"He","year":"2024","journal-title":"World Neurosurg."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","article-title":"Measuring inconsistency in meta-analyses","volume":"327","author":"Higgins","year":"2003","journal-title":"BMJ"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1267","DOI":"10.1089\/neu.2020.7473","article-title":"Characterizing natural recovery after traumatic spinal cord injury","volume":"38","author":"Kirshblum","year":"2021","journal-title":"J. Neurotrauma"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1186\/s12984-025-01649-1","article-title":"Comparative efficacy of robotic exoskeleton and conventional gait training in patients with spinal cord injury: a meta-analysis of randomized controlled trials","volume":"22","author":"Liu","year":"2025","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1304153","DOI":"10.3389\/fneur.2023.1304153","article-title":"Spinal cord injury: global burden from 1990 to 2019 and projections up to 2030 using Bayesian age-period-cohort analysis","volume":"14","author":"Liu","year":"2023","journal-title":"Front. Neurol."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1186\/s12916-024-03514-9","article-title":"Global incidence and characteristics of spinal cord injury since 2000-2021: a systematic review and meta-analysis","volume":"22","author":"Lu","year":"2024","journal-title":"BMC Med."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"722","DOI":"10.1038\/sc.2017.31","article-title":"Is body-weight-supported treadmill training or robotic-assisted gait training superior to overground gait training and other forms of physiotherapy in people with spinal cord injury? A systematic review","volume":"55","author":"Mehrholz","year":"2017","journal-title":"Spinal Cord"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"604","DOI":"10.1007\/s13311-018-0642-3","article-title":"Robotic rehabilitation and spinal cord injury: a narrative review","volume":"15","author":"Mekki","year":"2018","journal-title":"Neurotherapeutics"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"455","DOI":"10.2147\/mder.S103102","article-title":"Clinical effectiveness and safety of powered exoskeleton-assisted walking in patients with spinal cord injury: systematic review with meta-analysis","volume":"9","author":"Miller","year":"2016","journal-title":"Med Devices (Auckl)."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jor.2024.10.036","article-title":"The use of exoskeleton robotic training on lower extremity function in spinal cord injuries: a systematic review","volume":"65","author":"Moriarty","year":"2024","journal-title":"J. Orthop."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1186\/s12984-024-01365-2","article-title":"Exoskeleton-based exercises for overground gait and balance rehabilitation in spinal cord injury: a systematic review of dose and dosage parameters","volume":"21","author":"Nepomuceno","year":"2024","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref22","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1499","DOI":"10.1007\/s11999-016-5133-4","article-title":"Classifications in brief: American spinal injury association (ASIA) impairment scale","volume":"475","author":"Roberts","year":"2017","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"g7647","DOI":"10.1136\/bmj.g7647","article-title":"Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation","volume":"350","author":"Shamseer","year":"2015","journal-title":"BMJ"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"i4919","DOI":"10.1136\/bmj.i4919","article-title":"ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions","volume":"355","author":"Sterne","year":"2016","journal-title":"BMJ"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1038\/sc.2008.162","article-title":"ASIA impairment scale conversion in traumatic SCI: is it related with the ability to walk? A descriptive comparison with functional ambulation outcome measures in 273 patients","volume":"47","author":"van Middendorp","year":"2009","journal-title":"Spinal Cord"}],"container-title":["Frontiers in Neuroscience"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnins.2026.1781656\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T06:43:42Z","timestamp":1773125022000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnins.2026.1781656\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,10]]},"references-count":27,"alternative-id":["10.3389\/fnins.2026.1781656"],"URL":"https:\/\/doi.org\/10.3389\/fnins.2026.1781656","relation":{},"ISSN":["1662-453X"],"issn-type":[{"value":"1662-453X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,10]]},"article-number":"1781656"}}