Systematic Review of Treadmill With Body Weight Therapy for Stroke

Review

. 2017 Aug 17;eight(viii):CD002840.

doi: 10.1002/14651858.CD002840.pub4.

Treadmill training and trunk weight support for walking after stroke

Affiliations

• PMID: 28815562
• PMCID: PMC6483714
• DOI: ten.1002/14651858.CD002840.pub4

Free PMC article

Review

Treadmill grooming and body weight support for walking after stroke

Jan Mehrholz  et al. Cochrane Database Syst Rev. 2017 .

Gratuitous PMC article

Abstract

Background: Treadmill training, with or without trunk weight support using a harness, is used in rehabilitation and might help to amend walking later stroke. This is an update of the Cochrane review offset published in 2003 and updated in 2005 and 2014.

Objectives: To determine if treadmill preparation and body weight support, individually or in combination, improve walking ability, quality of life, activities of daily living, dependency or death, and institutionalisation or decease, compared with other physiotherapy gait-grooming interventions after stroke. The secondary objective was to decide the safe and acceptability of this method of gait training.

Search methods: We searched the Cochrane Stroke Grouping Trials Register (last searched 14 Feb 2017), the Cochrane Cardinal Register of Controlled Trials (CENTRAL) and the Database of Reviews of Effects (Cartel) (the Cochrane Library 2017, Effect two), MEDLINE (1966 to 14 February 2017), Embase (1980 to fourteen February 2017), CINAHL (1982 to 14 February 2017), AMED (1985 to 14 February 2017) and SPORTDiscus (1949 to 14 February 2017). We also handsearched relevant briefing proceedings and ongoing trials and research registers, screened reference lists, and contacted trialists to identify farther trials.

Option criteria: Randomised or quasi-randomised controlled and cantankerous-over trials of treadmill grooming and trunk weight support, individually or in combination, for the treatment of walking subsequently stroke.

Data collection and analysis: 2 review authors independently selected trials, extracted data, and assessed risk of bias and methodological quality. The primary outcomes investigated were walking speed, endurance, and dependency.

Main results: We included 56 trials with 3105 participants in this updated review. The average historic period of the participants was 60 years, and the studies were carried out in both inpatient and outpatient settings. All participants had at least some walking difficulties and many could not walk without assistance. Overall, the use of treadmill preparation did not increase the chances of walking independently compared with other physiotherapy interventions (hazard difference (RD) -0.00, 95% conviction interval (CI) -0.02 to 0.02; eighteen trials, 1210 participants; P = 0.94; I² = 0%; low-quality evidence). Overall, the use of treadmill training in walking rehabilitation for people afterward stroke increased the walking velocity and walking endurance significantly. The pooled mean difference (MD) (random-effects model) for walking velocity was 0.06 m/s (95% CI 0.03 to 0.09; 47 trials, 2323 participants; P < 0.0001; I² = 44%; moderate-quality evidence) and the pooled MD for walking endurance was 14.19 metres (95% CI two.92 to 25.46; 28 trials, 1680 participants; P = 0.01; I² = 27%; moderate-quality show). Overall, the use of treadmill training with body weight support in walking rehabilitation for people after stroke did not increment the walking velocity and walking endurance at the stop of scheduled follow-upward. The pooled Dr. (random-effects model) for walking velocity was 0.03 chiliad/south (95% CI -0.05 to 0.10; 12 trials, 954 participants; P = 0.50; I² = 55%; depression-quality evidence) and the pooled Doctor for walking endurance was 21.64 metres (95% CI -four.70 to 47.98; 10 trials, 882 participants; P = 0.11; I² = 47%; low-quality evidence). In 38 studies with a full of 1571 participants who were independent in walking at study onset, the use of treadmill grooming increased the walking velocity significantly. The pooled MD (random-effects model) for walking velocity was 0.08 g/southward (95% CI 0.05 to 0.12; P < 0.00001; I² = 49%). At that place were insufficient information to comment on whatever furnishings on quality of life or activities of daily living. Adverse events and dropouts did not occur more than frequently in people receiving treadmill training and these were not judged to be clinically serious events.

Authors' conclusions: Overall, people subsequently stroke who receive treadmill grooming, with or without torso weight support, are not more likely to meliorate their ability to walk independently compared with people after stroke not receiving treadmill training, just walking speed and walking endurance may improve slightly in the short term. Specifically, people with stroke who are able to walk (simply not people who are dependent in walking at start of treatment) appear to benefit most from this type of intervention with regard to walking speed and walking endurance. This review did not find, withal, that improvements in walking speed and endurance may have persisting beneficial furnishings. Further research should specifically investigate the furnishings of different frequencies, durations, or intensities (in terms of speed increments and inclination) of treadmill preparation, also as the use of handrails, in ambulatory participants, merely not in dependent walkers.

Conflict of interest argument

Bernhard Elsner: none known. Simone Thomas: none known. Jan Mehrholz: author of one included trial (Pohl 2002). He did not participate in quality cess and information extraction for this written report.

Figures

ane

Flow diagram. Delight note that the number of total‐texts is not necessarily equal to the number of studies that means that there often are several full‐texts of a single trial (e.g. as is the case for Ada 2003 or DEGAS 2007).

two

'Take a chance of bias' summary: review authors' judgements about each take chances of bias detail for each included study.

3

Funnel plot of comparing: 1 Treadmill (with or without torso weight support) versus other intervention, outcome: 1.1 Walking speed (m/due south) at end of treatment.

4

Funnel plot of comparison: 1 Treadmill (with or without body weight support) versus other intervention, result: 1.2 Walking endurance (g) at terminate of treatment.

1.ane. Analysis

Comparing 1 Treadmill (with or without body weight support) versus other intervention, Upshot 1 Walking speed (1000/s) at end of handling.

1.2. Assay

Comparison one Treadmill (with or without trunk weight back up) versus other intervention, Outcome ii Walking endurance (g) at cease of treatment.

two.1. Analysis

Comparison 2 Treadmill and body weight support versus other interventions, Result 1 Dependence on personal assist to walk at end of treatment.

2.2. Analysis

Comparison 2 Treadmill and body weight support versus other interventions, Result 2 Walking speed (m/due south) at finish of treatment.

2.three. Analysis

Comparing 2 Treadmill and torso weight back up versus other interventions, Outcome 3 Walking endurance (grand) at end of treatment.

ii.4. Analysis

Comparison 2 Treadmill and body weight support versus other interventions, Outcome iv Dependence on personal assist to walk at end of scheduled follow‐up.

2.five. Analysis

Comparing 2 Treadmill and trunk weight support versus other interventions, Outcome 5 Walking speed (m/s) at end of scheduled follow‐upwards.

2.6. Analysis

Comparison 2 Treadmill and body weight support versus other interventions, Result six Walking endurance (m) at end of scheduled follow‐upward.

3.1. Assay

Comparison 3 Treadmill grooming without body weight support versus other interventions, Outcome 1 Walking speed (1000/s) at end of handling.

3.2. Assay

Comparison 3 Treadmill training without body weight support versus other interventions, Issue ii Walking endurance (thousand) at end of treatment.

4.ane. Analysis

Comparison 4 Treadmill and torso weight support versus treadmill only, Outcome one Dependence on personal assistance to walk at stop of treatment.

iv.2. Analysis

Comparison iv Treadmill and body weight back up versus treadmill only, Event 2 Walking speed (m/south) at finish of treatment.

4.3. Analysis

Comparison 4 Treadmill and trunk weight support versus treadmill only, Outcome 3 Walking endurance (m) at cease of treatment.

4.4. Analysis

Comparison 4 Treadmill and body weight support versus treadmill only, Consequence 4 Dependence on personal help to walk at finish of scheduled follow‐up.

four.five. Assay

Comparison four Treadmill and body weight support versus treadmill only, Result 5 Walking speed (grand/s) at end of scheduled follow‐up.

4.6. Assay

Comparing 4 Treadmill and body weight back up versus treadmill but, Outcome 6 Walking endurance (m) at stop of scheduled follow‐upwards.

5.i. Assay

Comparison 5 Agin events for all included trials, Issue i Adverse events during the handling.

vi.1. Analysis

Comparison vi Dropouts for all included trials, Result 1 Dropouts.

7.1. Analysis

Comparison vii Sensitivity analysis: by trial methodology (all trials involving treadmill training), Effect one Walking speed.

8.i. Analysis

Comparison 8 Subgroup assay: treadmill (with or without body weight support) versus other, past duration of disease (independent in walking only), Outcome ane Walking speed (yard/s) at end of treatment.

8.2. Analysis

Comparison eight Subgroup assay: treadmill (with or without body weight support) versus other, by duration of affliction (independent in walking only), Outcome ii Walking endurance (grand) at stop of handling.

9.1. Analysis

Comparing 9 Subgroup assay: treadmill (with or without body weight back up) versus other, by intensity (frequency) of grooming (independent in walking only), Event 1 Walking speed (thousand/s) at end of handling.

9.2. Analysis

Comparison ix Subgroup assay: treadmill (with or without body weight back up) versus other, by intensity (frequency) of training (contained in walking only), Outcome two Walking endurance (one thousand) at end of handling.

x.1. Analysis

Comparison ten Subgroup assay: treadmill (with or without trunk weight support) versus other, past duration of training period (independent in walking only), Consequence 1 Walking speed (m/s) at end of treatment.

10.two. Assay

Comparison x Subgroup analysis: treadmill (with or without body weight support) versus other, by duration of training period (independent in walking but), Outcome 2 Walking endurance (1000) at end of treatment.

Update of

• Treadmill training and body weight support for walking after stroke.

  Mehrholz J, Pohl M, Elsner B. Mehrholz J, et al. Cochrane Database Syst Rev. 2014 Jan 23;2014(one):CD002840. doi: 10.1002/14651858.CD002840.pub3. Cochrane Database Syst Rev. 2014. PMID: 24458944 Free PMC article. Updated. Review.

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• Treadmill training and torso weight support for walking after stroke.

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Source: https://pubmed.ncbi.nlm.nih.gov/28815562/

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