Rehabilitating Walking Speed Poststroke With Treadmill-Based Interventions: A Systematic Review of Randomized Controlled Trials

Unbelievable, they still are trying to figure out correct stroke protocols for walking. You were just a guinea pig for an unplanned experiment by your physical therapist.  And yet you paid them full price.
http://nnr.sagepub.com/content/27/8/709.abstract?etoc

1. Charalambos C. Charalambous, MS1
2. Heather Shaw Bonilha, PhD1
3. Steven A. Kautz, PhD1,2
4. Chris M. Gregory, PhD1,2
5. Mark G. Bowden, PhD1,2

1. ¹Medical University of South Carolina, Charleston, SC, USA
2. ²Ralph H. Johnson VA Medical Center, Charleston, SC, USA

1. Mark G. Bowden, PhD, 77 President St., MSC 700, Charleston, SC 29425-7000, USA. Email: bowdenm@musc.edu

Abstract

Background. In the past several years, several randomized controlled trials (RCTs) have been reported regarding the efficacy of treadmill-based walking-specific rehabilitation programs, either individually (TT) or combined with body weight support (BWSTT), over control group therapies poststroke. No clear consensus exists as to whether treadmill-based interventions are superior in rehabilitating walking speed (WS) poststroke. Objective. To review published RCTs examining TT and BWSTT poststroke and describe the effects on improving and retaining WS. Methods. A systematic literature search in computerized databases was conducted to identify RCTs whose methodological quality was assessed with PEDro. Pre- and post-WS, change in WS, functional outcomes, and follow-up speed were extracted and calculated from each study. Additionally, statistical results of each study were examined, and the intragroup and intergroup effect sizes (ES_intra and ES_inter, respectively) were calculated. Results. All studies (8 TT; 7 BWSTT) met the inclusion criteria, and their methodological quality was generally good, with a mean PEDro score 6.9/10. Of the 15 studies, 8 studies (4 TT; 4 BWSTT) reported intragroup significant increases of WS, whereas only 4 (4 TT) found superiority of treadmill interventions. Nine studies demonstrated large ES_intra (4 TT; 5 BWSTT), yet only 3 showed large ES_inter (1 TT; 2 BWSTT). Four studies (2 TT and 2 BWSTT) reported retention of gains in WS, regardless of intervention. Conclusions. Treadmill-based interventions poststroke may increase and retain WS, but their universal superiority to other control group therapies has failed to be established.