Exploratory analysis of randomized clinical trials in physiotherapy aimed at improving walking speed after stroke

Treadmill walking improves walking speed and distance in ambulatory people after stroke and is not inferior to overground walking: a systematic review

QUESTIONS

Does mechanically assisted walking improve walking speed, distance and participation compared with no/non-walking intervention or overground walking after stroke? Are any benefits maintained beyond the intervention period?

DESIGN

Systematic review of randomised trials with meta-analysis.

PARTICIPANTS

Ambulatory adults at any time after stroke.

INTERVENTION

Mechanically assisted walking (treadmill or gait trainer) without body weight support.

OUTCOME MEASURES

Walking speed, walking distance and participation.

RESULTS

Sixteen trials involving 713 participants were included. The mean PEDro score of the trials was 6.3 (range 4 to 8). Treadmill walking increased walking speed by 0.13 m/s (95% CI 0.08 to 0.19) and distance by 46 m (95% CI 24 to 68) compared with no/non-walking intervention; these effects were largely maintained beyond the intervention. Treadmill walking had a similar or better effect on walking speed (MD 0.07 m/s, 95% CI 0.00 to 0.13) and distance (MD 18 m, 95% CI 1 to 36) compared with overground walking. The estimate of the relative effect of treadmill walking compared with overground walking on participation was very imprecise (SMD 0.16, 95% CI -0.15 to 0.48).

CONCLUSION

This systematic review provides moderate-quality evidence that the effect of treadmill walking is the same as or better than the effect of overground walking for improving walking speed and distance in ambulatory people after stroke. Long-term effects and carryover benefits to participation remain uncertain.

REVIEW REGISTRATION

PROSPERO (CRD42020162778).