Effects of Passive Lower-limb Exoskeleton-assisted Training on Motor and Daily Function Improvements in Older Adults

Primary outcomes

1. Change scores of Five Times Sit to Stand Test (FTSST)

   Time frame: Baseline, post test after completing 12 intervention sessions (around 4 weeks after baseline), follow up test (1 month after completing intervention sessions)]

   The FTSST measures the time taken to stand five times from a sitting position as fast as possible, which is used to assess functional lower limb strength, balance control, and mobility in both healthy adults and those with pathologies. The FTSST has been proven to be safe and to have excellent reliability.

2. Change scores of Timed Up and Go Test (TUG)

   Time frame: Baseline, post test after completing 12 intervention sessions (around 4 weeks after baseline), follow up test (1 month after completing intervention sessions)]

   The TUG test assesses dynamic balance ability and mobility. The participants will be required to stand up from a chair, walk 3 m, turn around, walk back to the chair, and sit down. Three trials will be taken at each assessment, and the average of three trials will be documented. The time to complete the TUG test has been shown to be a good indicator to detect potential fallers in frail elderly individuals. The TUG is a reliable, valid, and easy-to-administer clinical tool.

3. Change scores of 10-meter walk test (10MWT)

   Time frame: Baseline, post test after completing 12 intervention sessions (around 4 weeks after baseline), follow up test (1 month after completing intervention sessions)]

   The 10MWT assesses walking speed in self-selected pace and fast walking pace, which can be employed to determine functional mobility. Two trials are administered at the participant's comfortable walking speed, followed by 2 trials at his/her fast walking speed. The 2 trials, for each speed, are averaged and the 2 gait speeds are documented in meters/second. The 10-meter walk test has demonstrated excellent

   reliability for comfortable and fastest gait speeds in healthy adults and other pathological populations.

4. Change scores of Nottingham Extended Activities of Daily Living Scale (NEADL)

   Time frame: Baseline, post test after completing 12 intervention sessions (around 4 weeks after baseline), follow up test (1 month after completing intervention sessions)]

   The NEADL is a measure of independence in 4 areas of daily life, including mobility, kitchen, domestic, and leisure activities. It includes 22 items, and each item is measured on a 4-point scale. The total score ranges from 0 to 66 and a higher score indicates better daily functional ability. The psychometric properties of the NEADL have been well established.

5. Change scores of Daily Living Self-Efficacy Scale (DLSES)

   Time frame: Baseline, post test after completing 12 intervention sessions (around 4 weeks after baseline), follow up test (1 month after completing intervention sessions)]

   The DLSES measures self-efficacy of daily functioning, including psychosocial functioning and activities of daily living. The scale consists of 12 items, and each item is measured on a 100-point scale with 10-unit intervals (0 = cannot do at all, 100 = highly certain can do). A higher score indicates higher level of self-efficacy. The DLSES is a psychometrically sound measure of self-efficacy in stroke survivors.

6. Change scores of Functional Abilities Confidence Scale (FACS)

   Time frame: Baseline, post test after completing 12 intervention sessions (around 4 weeks after baseline), follow up test (1 month after completing intervention sessions)]

   The FACS measures the degree of self-efficacy and confidence when the participants perform various movements and postures. It consists of 15 questions scoring from 0% (not confidence at all) to 100% (fully confidence). A higher score indicates higher confidence of performing the movements. The psychometric properties are good.

7. Change scores of Mini-Mental State Examination (MMSE)

   Time frame: Baseline, post test after completing 12 intervention sessions (around 4 weeks after baseline), follow up test (1 month after completing intervention sessions)]

   The MMSE a 30-point questionnaire that is the most commonly used brief screening tool for detecting cognitive impairment. Higher values represent a better cognitive functioning. The MMSE has good psychometric properties for identifying cognitive impairment.