Effects of Gait Training with Lower-Limb Robotic Exoskeletons and Exoskeleton-Type Devices on Gait Symmetry and Gait Speed in Patients with Stroke: A Systematic Review and Meta-Analysis

Gait asymmetry and reduced gait speed (GS) are common after stroke. This systematic review and meta-analysis evaluated the effects of gait training with lower-limb robotic exoskeletons or exoskeleton-type devices on gait asymmetry and GS compared with conventional rehabilitation or non-robotic gait training. PubMed, Embase, Web of Science, the Cochrane Library, and Scopus were searched from inception to 21 June 2026. Randomized controlled trials (RCTs) reporting spatial gait asymmetry (SGA), temporal gait asymmetry (TGA), or GS were included. Standardized mean differences (SMDs; Hedges’ g) and 95% confidence intervals (CIs) were pooled using random-effects models. Eleven RCTs involving 532 randomized participants were included. Training with these devices reduced SGA (SMD = −0.68, 95% CI −1.13 to −0.22, p < 0.01) and improved GS (SMD = 0.46, 95% CI 0.12 to 0.81, p = 0.01), but did not significantly affect TGA (SMD = −0.85, 95% CI −1.90 to 0.20, p = 0.11). The certainty of evidence, assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework, was very low for all three outcomes. Gait training with lower-limb robotic exoskeletons or exoskeleton-type devices may reduce SGA and improve GS after stroke, whereas its effect on TGA remains uncertain.