This trial found no clear superiority of RAGT+CPT over CPT for walking ability or basic ADL, though RAGT+CPT was associated with greater improvement in self-perceived health-related quality of life, suggesting RAGT may be considered a complementary rehabilitation approach rather than a universally superior alternative to conventional physiotherapy.
Key Findings
Results
Both RAGT+CPT and CPT produced significant improvements over time in walking ability and basic ADL, but no differential treatment effect between interventions was found.
100 people with subacute or chronic stroke were randomized 1:1 to RAGT+CPT or CPT
Primary outcomes were walking ability (Functional Ambulation Categories) and basic ADL (Barthel Index)
Cumulative link mixed models demonstrated 'significant improvements over time in walking ability and basic ADL, with no evidence of differential treatment effects between RAGT+CPT and CPT'
Analyses followed the intention-to-treat principle
Additional analyses adjusting for baseline ambulatory function 'did not materially alter the intervention-related conclusions'
Results
Self-perceived health-related quality of life improved significantly more in the RAGT+CPT group than the CPT group.
HRQoL was assessed using the EQ-5D-5L Visual Analogue Scale
The EQ-5D-5L VAS improvement was significantly greater following RAGT+CPT than CPT
Most other secondary outcomes were comparable between interventions
Secondary outcomes included walking speed and distance, functional mobility, concerns about falling, fatigue, and HRQoL
Results
Improvements in walking endurance were greater in subacute-phase participants than in chronic-phase participants.
Participants were stratified by stroke phase: subacute (>7 days to ≤6 months) or chronic (>6 months)
Walking endurance was among the secondary outcomes assessed
This differential improvement by stroke phase was observed across both treatment groups
Median baseline FAC was 4 (range 0–4 in both subgroups) in the subacute groups and 3 (range 0–4 in both subgroups) in the chronic groups
Methods
The intervention protocol consisted of 4 weeks of inpatient rehabilitation delivered four times weekly, combining robot-assisted or conventional physiotherapy with additional conventional physiotherapy.
Sessions were delivered four times weekly for 4 weeks
Each session comprised 45–50 minutes of RAGT or CPT plus 25 minutes of CPT
An end-effector-based RAGT device was used in the RAGT+CPT group
Outcomes were assessed at baseline, post-intervention, and at follow-up (Week 12)
The trial was single-blind and parallel-group in design
Results
No study-related serious adverse events occurred during the trial.
Safety was monitored across both intervention groups
The absence of serious adverse events was reported for both RAGT+CPT and CPT conditions
This finding supports the safety of end-effector-based RAGT in both subacute and chronic stroke populations
Results
Both interventions produced meaningful improvements over time across both stroke phases, supporting intensive inpatient rehabilitation beyond the early recovery phase.
The study included both subacute (>7 days to ≤6 months) and chronic (>6 months) stroke survivors
Improvements were observed in both groups regardless of treatment allocation
The authors concluded that findings support 'intensive inpatient rehabilitation beyond the early recovery phase'
The effectiveness of RAGT 'across different recovery stages' was a specific focus of the trial
What This Means
This research suggests that adding robot-assisted gait training (RAGT) to conventional physiotherapy does not produce greater improvements in walking ability or everyday activities compared to conventional physiotherapy alone for people recovering from stroke. The study followed 100 stroke survivors — some in the subacute phase (one week to six months post-stroke) and some in the chronic phase (more than six months post-stroke) — through a four-week intensive inpatient rehabilitation program. Both groups improved meaningfully over the course of the study, and no serious safety concerns arose in either group.
One notable difference was that participants who received robot-assisted training reported greater improvements in how they perceived their own quality of life, even though objective measures of walking and daily function were similar between groups. The study also found that improvements in walking endurance were larger for people in the earlier (subacute) phase of recovery compared to those in the chronic phase, regardless of which treatment they received. This highlights that the timing of rehabilitation after stroke may influence how much benefit people gain.
This research suggests that robot-assisted gait training may be best understood as a complementary option rather than a replacement for conventional physiotherapy. It may offer benefits related to patients' sense of well-being and quality of life, and it appears safe to use across both early and later stages of stroke recovery. The findings also reinforce the value of intensive inpatient rehabilitation even for people who are months or years beyond their stroke.
Stampfer-Kountchev M, Mildner S, Hotz I, Habig J, Pröglhöf M, Panzl J, et al.. (2026). Robot-assisted gait training in people with subacute and chronic stroke: a randomized controlled trial.. Frontiers in neurology. https://doi.org/10.3389/fneur.2026.1898475