Effect of robotic-assisted gait training on gait and motor function in spinal cord injury: a protocol of a systematic review with meta-analysis

Introduction Robotic-assisted gait training (RAGT) has been reported to be effective in rehabilitating patients with spinal cord injury (SCI). However, studies on RAGT showed different results due to a varied number of samples. Thus, summarising studies based on robotic-related factors is critical for the accurate estimation of the effects of RAGT on SCI. This work aims to search for strong evidence showing that using RAGT is effective in treating SCI and analyse the deficiencies of current studies. Methods and analysis The following publication databases were electronically searched in December 2022 without restrictions on publication year: MEDLINE, Cochrane Library, Web of Science, Embase, PubMed, the Cochrane Central Register of Controlled Trials and China National Knowledge Infrastructure. Various combinations of keywords, including ‘motor disorders’, ‘robotics’, ‘robotic-assisted gait training’, ‘Spinal Cord Injuries’, ‘SCI’ and ‘gait analysis’ were used as search terms. All articles on randomised controlled trials (excluding retrospective trials) using RAGT to treat SCI that were published in English and Chinese and met the inclusion criteria were included. Outcomes included motor function, and gait parameters included those assessed by using the instrumented gait assessment, the Berg Balance Scale, the 10-m walk speed test, the 6-min walk endurance test, the functional ambulation category scale, the Walking index of SCI and the American Spinal Injury Association assessment scale. Research selection, data extraction and quality assessment were conducted independently by two reviewers to ensure that all relevant studies were free from personal bias. In addition, the Cochrane risk-of-bias assessment tool was used to assess the risk of bias. Review Manager V.5.3 software was used to produce deviation risk maps and perform paired meta-analyses. Ethics and dissemination Ethics approval is not required for systematic reviews and network meta-analyses. The results will be submitted to a peer-reviewed journal or presented at a conference. PROSPERO registration number CRD42022319555.

3. In terms of data extraction, the extracted data included information on study type, basic patient information, inclusion exclusion criteria, and intervention such as time, frequency, and intensity etc.For missing information, they took the approach of contacting the author.In the absence of a reply ,they calculate available factors, and analyzed the impact of missing data on the Meta-analysis results by sensitivity.Because it was the protocol of Meta-analysis, the specific informations of treatment-related interventions were not mentioned.4. the statistical software used and some basic statistical descriptors are not described.Reviewer: 2

REVIEWER
1.The references are too few and not new enough.
According to the suggestion of the reviewer(professor), We have added 10 references from the past three years, increasing the number and novelty of references..

Languages need to be modified by native speakers.
According to the suggestion of the reviewer(professor), we found professional editors in our research group to make further revisions to the writing of the manuscript, in order to improve the writing quality of the manuscript.
3.What's new about this scheme and previous studies like this one, which have already been published?Before preparing the writing of the plan, a preliminary search was conducted.In the end, a systematic review was conducted without meta-analysis, and intervention factors included robots and weight loss treadmills.In summary, our research mainly focuses on exploring the effects of robots on gait and motor function in patients with spinal cord injury, which is not covered by other studies and is also an innovative point of our research.
4.TheIntroduction and Discussion are too little and need to be improved.
According to the suggestion of the reviewer(professor), Some modifications have been made in the introduction section, as the article type is a protocol, which is limited in the introduction and discussion section, making it impossible to conduct in-depth discussions, resulting in a lack of all content.
5.What does TSCI mean, which is only abbreviated.Thank you very much for the questions raised by the reviewers.After careful inspection by the team, it has been confirmed that the letter T in the abbreviation (TSCI) was caused by a clerical error, and the correct one is SCI.Thank you again.The team members have carefully reviewed the article and should prevent such issues from occurring.
6.Please upload Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols Guideline and Cochrane Collaboration.
According to the suggestion of the reviewer(professor), We have supplemented the PRISMA-P checklist and indicated the line number of your manuscript.
7.Please revise and improve the manuscript in detail.
According to the suggestion of the reviewer(professor), our team has further improved and revised the article, including multiple parts such as the introduction and methods.Reply: In response to the reviewer's first comment, our research team is not very clear about which part of the content it refers to.If it refers to the suggestions for the method section, our research team has made modifications based on the reviewer's first comment.
2 Were retrospective trials included?If not, make it clear in the abstract.
Reply: Excluding retrospective trials.According to the suggestion of the reviewer, additional explanations have been provided in the abstract section of the manuscript 3Applied keywords used in the searching process have to be clearly described in the abstract.
Reply: According to the suggestion of the reviewer.The keywords used in the search process have been supplemented in the abstract section of the manuscript.4.Regarding the statistical analysis section, subgroup analysis should be described in much more detail.
Thanks again for the comments of experts on the manuscript!Line 152-153.The risk map of the biases of the studies' quality was prepared with RevMan 5.2 software.Line 158.A metaanalysis will be conducted by using Review Manager 5.3."Please explain why Revman is not the same version 6.The discussion is too short and not deep enough.Please focus on the research for further detailed elaboration.7. What are the limitations of the study?Please add.It should clear the methods and higherchy of the evidence and the level also.