Effectiveness of Treadmill Retraining on Gait of Hemiparetic Stroke Patients

Summary Background Treadmill retraining of gait has been proposed as a useful adjunct to conventional physical therapy to restore ability to walk after stroke. Aim To inform clinical practice by evaluating the research evidence for the effectiveness of treadmill retraining of gait after stroke. Design A systematic review. Search strategy An electronic search of Medline, Embase, Cinahl, Amed and PEDro combined with a hand search of papers published in relevant peer-reviewed journals. Inclusion criteria for and identification of studies Published, human, English language, controlled studies investigating treadmill retraining of gait for adults with a diagnosis of stroke and hemiplegia. The two authors independently examined the abstracts of studies highlighted to identify those which met the inclusion criteria. Data collection and analysis Studies which met the inclusion criteria were reviewed by both authors independently and classified into categories: treadmill versus no treatment, treadmill plus partial bodyweight support (PBWS) versus no treatment, treadmill plus PBWS versus treadmill, treadmill versus physical therapy and treadmill plus PBWS versus physical therapy. Each author independently extracted relevant data on the subjects, study design, interventions, outcome measures and results. Any disagreements were resolved through discussion. Findings Twelve studies fulfilled the inclusion criteria – five single case studies and seven randomised controlled trials. The review suggests that although treadmill retraining of gait, especially with PBWS, might improve gait parameters and functional mobility, unless treadmill retraining is directed at improving gait speed it might be no more effective than conventional physical therapy at improving gait parameters. Limitations The findings of this review are limited by a lack of comprehensive investigation of conventional physical therapy interventions, difficulty comparing primary studies which investigated subjects at different time points after stroke using a variety of outcome measures, and the quality of the included primary studies. Implications for clinical practice This review suggests that there is little evidence as yet to justify changing clinical practice in favour of treadmill retraining of gait after stroke.