Treadmill training is effective for ambulatory adults with stroke: a systematic review

QuestionDoes mechanically assisted walking increase walking speed or distance in ambulatory people with stroke compared with no intervention/non-walking intervention, or with overground walking?DesignSystematic review with meta-analysis of randomised trials.ParticipantsAmbulatory adults with stroke.InterventionMechanically assisted walking (treadmill or gait trainer) without body weight support.Outcome measuresWalking speed measured in m/s during the 10-m Walk Test and walking distance measured in m during the 6-min Walk Test.ResultsNine studies of treadmill training comprising 977 participants were included. Treadmill training resulted in faster walking than no intervention/non-walking intervention immediately after the intervention period (MD 0.14 m/s, 95% CI 0.09 to 0.19) and this was maintained beyond the intervention period (MD −0.12 m/s, 95% CI 0.08 to 0.17). It also resulted in greater walking distance immediately after the intervention period (MD 40 m, 95% CI 27 to 53) and this was also maintained beyond the intervention period (MD 40 m, 95% CI 24 to 55). There was no immediate, statistically significant difference between treadmill training and overground training in terms of walking speed (MD 0.05 m/s, 95% CI 0.12 to 0.21) or distance (MD −6 m, 95% CI −45 to 33).ConclusionThis systematic review provides evidence that, for people with stroke who can walk, treadmill training without body weight support results in faster walking speed and greater distance than no intervention/ non-walking intervention and the benefit is maintained beyond the training period.