Is body-weight-supported treadmill training or robotic-assisted gait training superior to overground gait training and other forms of physiotherapy in people with spinal cord injury? A systematic review

Study design:Systematic review about randomised trials comparing different training strategies to improve gait in people with spinal cord injuries (SCI).Objectives:The aim of this systematic review was to compare the effectiveness of body-weight-supported treadmill training (BWSTT) and robotic-assisted gait training with overground gait training and other forms of physiotherapy in people with traumatic SCI.Setting:Systematic review conducted by researchers from Germany and Australia.Methods:An extensive search was conducted for randomised controlled trials involving people with traumatic SCI that compared either BWSTT or robotic-assisted gait training with overground gait training and other forms of physiotherapy. The two outcomes of interest were walking speed (m s−1) and walking distance (m). BWSTT and robotic-assisted gait training were analysed separately, and data were pooled across trials to derive mean between-group differences using a random-effects model.Results:Thirteen randomised controlled trials involving 586 people were identified. Ten trials involving 462 participants compared BWSTT to overground gait training and other forms of physiotherapy, but only nine trials provided useable data. The pooled mean (95% confidence interval (CI)) between-group differences for walking speed and walking distance were −0.03 m s−1 (−0.10 to 0.04) and −7 m (−45 to 31), respectively, favouring overground gait training. Five trials involving 344 participants compared robotic-assisted gait training to overground gait training and other forms of physiotherapy but only three provided useable data. The pooled mean (95% CI) between-group differences for walking speed and walking distance were −0.04 m s−1 (95% CI −0.21 to 0.13) and −6 m (95% CI −86 to 74), respectively, favouring overground gait training.Conclusions:BWSTT and robotic-assisted gait training do not increase walking speed more than overground gait training and other forms of physiotherapy do, but their effects on walking distance are not clear.

[1]  M. Kenward,et al.  Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls , 2009, BMJ : British Medical Journal.

[2]  S. Heydar,et al.  The Effect of Body-Weight-Supported Training Exercises on Functional Ambulation Profile in Patients with Paraplegic Spinal Cord Injury , 2015 .

[3]  Fiona Moffat,et al.  Effects of locomotor training after incomplete spinal cord injury: a systematic review. , 2013, Archives of physical medicine and rehabilitation.

[4]  Nerys Brick,et al.  Locomotor training for walking after spinal cord injury. , 2014, Orthopedic nursing.

[5]  Na Young Kim,et al.  Effect of Robotic-Assisted Gait Training in Patients With Incomplete Spinal Cord Injury , 2014, Annals of rehabilitation medicine.

[6]  Lisa A. Harvey,et al.  Management of Spinal Cord Injuries: A Guide for Physiotherapists , 2008 .

[7]  Rob Labruyère,et al.  Strength training versus robot-assisted gait training after incomplete spinal cord injury: a randomized pilot study in patients depending on walking assistance , 2014, Journal of NeuroEngineering and Rehabilitation.

[8]  G. Dudley,et al.  Weight-supported treadmill vs over-ground training for walking after acute incomplete SCI , 2006, Neurology.

[9]  George Tharion,et al.  Comparison of body weight-supported treadmill training versus body weight-supported overground training in people with incomplete tetraplegia: a pilot randomized trial , 2015, Clinical rehabilitation.

[10]  Roger L. Brown,et al.  Sufficiently Important Difference: Expanding the Framework of Clinical Significance , 2005, Medical decision making : an international journal of the Society for Medical Decision Making.

[11]  P. Lucareli,et al.  Gait analysis following treadmill training with body weight support versus conventional physical therapy: a prospective randomized controlled single blind study , 2011, Spinal Cord.

[12]  Jaynie F. Yang,et al.  Repetitive Mass Practice or Focused Precise Practice for Retraining Walking After Incomplete Spinal Cord Injury? A Pilot Randomized Clinical Trial , 2014, Neurorehabilitation and neural repair.

[13]  Malcolm H Granat,et al.  Functional electric stimulation to augment partial weight-bearing supported treadmill training for patients with acute incomplete spinal cord injury: A pilot study. , 2004, Archives of physical medicine and rehabilitation.

[14]  A. Wernig,et al.  Weight-supported treadmill vs over-ground training for walking after acute incomplete SCI , 2006, Neurology.

[15]  Ana Esclarín-Ruz,et al.  A comparison of robotic walking therapy and conventional walking therapy in individuals with upper versus lower motor neuron lesions: a randomized controlled trial. , 2014, Archives of physical medicine and rehabilitation.

[16]  B. Dobkin,et al.  Should Body Weight–Supported Treadmill Training and Robotic-Assistive Steppers for Locomotor Training Trot Back to the Starting Gate? , 2012, Neurorehabilitation and neural repair.

[17]  L. Harvey,et al.  The effectiveness of 22 commonly administered physiotherapy interventions for people with spinal cord injury: a systematic review , 2016, Spinal Cord.

[18]  P. Jacobs,et al.  Comparison of training methods to improve walking in persons with chronic spinal cord injury: a randomized clinical trial , 2011, The journal of spinal cord medicine.

[19]  Gordon H Guyatt,et al.  Credibility of claims of subgroup effects in randomised controlled trials: systematic review , 2012, BMJ : British Medical Journal.

[20]  H. Sadeghi,et al.  The Effect of BodyWeight-Supported Training Exercises on Functional Ambulation Profile in Patients with Paraplegic Spinal Cord Injury , 2015 .

[21]  Jiming Liu,et al.  Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range , 2014, BMC Medical Research Methodology.

[22]  S. Harkema.  Neural Plasticity after Human Spinal Cord Injury: Application of Locomotor Training to the Rehabilitation of Walking , 2001, The Neuroscientist : a review journal bringing neurobiology, neurology and psychiatry.

[23]  L. Harvey.  Chapter 10 – Pain management , 2008 .

[24]  M. Popovic,et al.  A randomized trial of functional electrical stimulation for walking in incomplete spinal cord injury: Effects on walking competency , 2014, The journal of spinal cord medicine.

[25]  Douglas G Altman,et al.  Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes: meta-epidemiological study , 2008, BMJ : British Medical Journal.

[26]  K. Roach,et al.  Influence of a Locomotor Training Approach on Walking Speed and Distance in People With Chronic Spinal Cord Injury: A Randomized Clinical Trial , 2011, Physical Therapy.

[27]  Xun Niu,et al.  Prediction of gait recovery in spinal cord injured individuals trained with robotic gait orthosis , 2014, Journal of NeuroEngineering and Rehabilitation.

[28]  Robotically assisted treadmill exercise training for improving peak fitness in chronic motor incomplete spinal cord injury: A randomized controlled trial , 2016, The journal of spinal cord medicine.

[29]  Mónica Alcobendas-Maestro,et al.  Lokomat Robotic-Assisted Versus Overground Training Within 3 to 6 Months of Incomplete Spinal Cord Lesion , 2012, Neurorehabilitation and neural repair.

[30]  S. Harkema,et al.  Locomotor training after human spinal cord injury: a series of case studies. , 2000, Physical therapy.

[31]  V. Dietz,et al.  Effectiveness of automated locomotor training in patients with chronic incomplete spinal cord injury: a multicenter trial. , 2005, Archives of physical medicine and rehabilitation.