Question: We wanted to assess whether treadmill training and body weight support, individually or in combination, could improve walking when compared with other gait training methods, placebo or no treatment.
Background: About 60% of people who have had a stroke have difficulties with walking, and improving walking is one of the main goals of rehabilitation. Treadmill training, with or without body weight support, uses specialist equipment to assist walking practice.
Study characteristics: We identified 44 relevant trials, involving 2658 participants, up to June 2013. Twenty-two studies (1588 participants) compared treadmill training with body weight support to another physiotherapy intervention; 16 studies (823 participants) compared treadmill training without body weight support to other physiotherapy intervention, no intervention or sham; two studies (100 participants) compared treadmill training with body weight support to treadmill training without body weight support; and four studies (147 participants) did not state whether they used body weight support or not. The average age of the participants ranged from 50 to 75 years, and the studies were carried out in both inpatient and outpatient settings.
Key results and quality of the evidence: The results of this review were partly conclusive. People after stroke who receive treadmill training with or without body weight support are not more likely to improve their ability to walk independently. The quality of this evidence was low. However, treadmill training with or without body weight support may improve walking speed and walking capacity compared with people not receiving treadmill training. The quality of this evidence was moderate. More specifically, people after stroke who are able to walk at the start of therapy appear to benefit most from this type of intervention, but people who are not able to walk independently at therapy onset do not benefit. This review found that improvements in walking speed and endurance in people who can walk may have persisting beneficial effects. However, our review suggests that stroke patients who are not able to walk independently at the start of treatment may not benefit from treadmill training with or without body weight support. Adverse events and drop outs did not occur more frequently in people receiving treadmill training. Subgroup analysis showed that treadmill training in the first three months after stroke produces statistically and clinically relevant improvements in walking speeds and endurance. For people treated in the chronic phase (i.e. more than six months post-stroke) the effects were lower. Treadmill training at higher frequencies may produce greater effects on walking speed and endurance; however, this was not significant.
In practice, treadmill training should be used when stroke patients can walk independently. Therapists should be aware that treadmill training may be used as an option but not as a stand-alone treatment to improve walking speed and endurance in people who are able to walk independently. It appears that people who can walk after stroke, but not those who cannot, may profit from treadmill training (with and without body weight support) to improve their walking abilities. Further research should specifically investigate the effects of different frequencies, durations or intensities (in terms of speed increments and inclination) of treadmill training, as well as the use of handrails. Future trials should include people who can already walk, but not dependent walkers who are unable to walk unaided.