Comment on “Dosing overground robotic gait training after spinal cord injury: a randomized clinical trial protocol”

Dear Editor,

I have carefully read the article “Dose Study of Overground Robotic Gait Training After Spinal Cord Injury: A Randomized Clinical Trial Protocol” written by Suhalka et al. [1], published in the 2024 issue of the journal “Trials.” This article aims to explore the impact of different treatment frequencies of robotic-assisted gait training (RAGT) on the rehabilitation outcomes of patients with spinal cord injury (SCI). This study has profound clinical significance. The following are my comments and suggestions on this article:

Comments

Great significance of the study

The restoration of walking function in patients with spinal cord injury is currently a medical challenge [2]. Most current studies focus on the comparative analysis of the therapeutic effects between RAGT and other rehabilitation trainings or on the study of the therapeutic effects of RAGT combined with other rehabilitation trainings [3]. There is a lack of research on the correlation between treatment frequency and rehabilitation outcomes. Through the design of a stepwise frequency intervention, this study aims to explore the optimal treatment frequency of RAGT for improving the rehabilitation outcomes of spinal cord injury (SCI) patients, providing an evidence-based basis for individualized rehabilitation programs. This further optimizes the rehabilitation treatment strategy and has great clinical significance.

Evaluation of multiple indicators

This study not only includes subjective indicators such as the Spinal Cord Independence Measure and the assessment of activities of daily living, but also includes the assessment of motor-evoked potential indicators. The assessment of motor-evoked potentials can objectively reveal the role of neural plasticity. Through the evaluation of multiple aspects, this study more comprehensively evaluates the rehabilitation effect of RAGT and neuronal plasticity.

Suggestions

Clarify the basis for dividing RAGT treatment frequencies

This study mentioned different RAGT modes with different treatment frequencies, but did not clearly mention the basis for dividing these different treatment frequencies. It is recommended that the authors further clarify the theoretical basis for dividing different treatment frequencies to make the formulated rehabilitation strategy more persuasive.

Clarify the inclusion criteria

The inclusion criteria of this study (such as the injury segment and the American Spinal Injury Association (ASIA) impairment scale) have not been clearly stated. Differences in the injury segment and ASIA impairment scale [4] of patients with SCI can lead to differences in the effectiveness of rehabilitation training, which affects the credibility of the research results. It is recommended that the authors conduct subgroup analyses or re-establish the inclusion criteria to eliminate such differences and ensure the credibility of the research results.

Formulation of the research protocol

This clinical study was conducted in a single rehabilitation hospital. Since the rehabilitation resources in different rehabilitation institutions or different regions are not consistent, this leads to differences in rehabilitation outcomes. It is recommended that the authors conduct a multicenter clinical study to ensure the credibility of the research results.

Increase monitoring and management measures for potential adverse reactions

Although RAGT is relatively safe, there is still a risk of muscle strains, joint injuries, joint pain, and even fractures. Some patients may experience symptoms such as dizziness and chest tightness due to hypotension. The occurrence of these symptoms not only threatens the safety of patients, but may also affect the evaluation of the effectiveness of RAGT. It is recommended that the authors strengthen the monitoring and recording of these adverse reactions during the research process and provide measures for the prevention and timely management of these adverse reactions to ensure the safety of patients and the accuracy of the research results.

Detection of safety indicators

Patients with spinal cord injury have a relatively high risk of falling. This study did not include an assessment of the risk of falling. It is recommended that the authors supplement the Berg Balance Scale [5] or specific fall risk assessment tools to evaluate the fall risk of patients.

Overall, this study has a clear research idea and a logical structure, providing an objective basis for the formulation of rehabilitation treatment strategies for patients with SCI. Although there are some deficiencies, through subsequent improvement and refinement, it can provide strong evidence support for the formulation of rehabilitation treatment programs for patients with SCI and promote the development of rehabilitation medicine.