Intervention Review

Treadmill training and body weight support for walking after stroke

  1. Anne M Moseley1,*,
  2. Angela Stark2,
  3. Ian D Cameron3,
  4. Alex Pollock4

Editorial Group: Cochrane Stroke Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 13 APR 2005

DOI: 10.1002/14651858.CD002840.pub2

Database Title

Additional Information

How to Cite

Moseley AM, Stark A, Cameron ID, Pollock A. Treadmill training and body weight support for walking after stroke. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD002840. DOI: 10.1002/14651858.CD002840.pub2.

Author Information

  1. 1

    The George Institute for International Health, University of Sydney, Centre for Evidence-Based Physiotherapy, Musculoskeletal Division, Sydney, NSW, Australia

  2. 2

    The University of Sydney, School of Physiotherapy, Lidcombe, NSW, Australia

  3. 3

    The University of Sydney, Rehabilitation Studies Unit, Northern Clinical School, Faculty of Medicine, Ryde, NSW, Australia

  4. 4

    Glasgow Caledonian University, Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow, UK

*Anne M Moseley, Centre for Evidence-Based Physiotherapy, Musculoskeletal Division, The George Institute for International Health, University of Sydney, Level 7, 341 George Street, Sydney, NSW, 2000, Australia. amoseley@george.org.au.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 21 JAN 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Treadmill training, with or without some body weight supported using a harness, is a method of treating walking after stroke.

Objectives

To assess the effectiveness of treadmill training and body weight support, individually or in combination, in the treatment of walking after stroke. The primary outcomes investigated were walking speed, endurance and dependency.

Search methods

We searched the Cochrane Stroke Group Trials Register (last searched 2 March 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2004), MEDLINE (1966 to January 2005), EMBASE (1980 to February 2005), CINAHL (1982 to February 2005) and PEDro (last searched 2 March 2005). We also handsearched relevant conference proceedings, screened reference lists and contacted trialists to identify further trials.

Selection criteria

Randomised or quasi-randomised controlled and cross-over trials of treadmill training and body weight support, individually or in combination, for the treatment of walking after stroke.

Data collection and analysis

Two authors independently selected trials, extracted data, and assessed quality. We used a fixed-effect model for analysis, but if heterogeneity existed a random-effects model was used. We analysed the results as weighted mean differences (WMD) for continuous variables and relative risk (RR) for dichotomous variables.

Main results

Fifteen trials (622 participants) were included. There were no statistically significant differences between treadmill training, with or without body weight support, and other interventions for walking speed or dependence. Among participants who could walk independently at the start of treatment, treadmill training with body weight support tended to produce higher walking speeds (WMD 0.09 m/s, 95% confidence interval (CI) -0.02 to 0.20 for speed; fixed-effect), but this result was not statistically significant. An individual trial tended to support the use of treadmill training with body weight support for dependent walkers as compared to treadmill training alone. One of three individual trials indicated that independent walkers may benefit from treadmill training combined with other task-orientated exercise. However, data are very limited. Adverse events occurred more frequently in participants receiving treadmill training but these were not judged to be clinically serious events.

Authors' conclusions

Overall no statistically significant effect of treadmill training with or without body weight support was detected. Although individual studies suggested that treadmill training with body weight support may be more effective than treadmill training alone and that treadmill training plus task-oriented exercise may be more effective than sham exercises, further trials are required to confirm these findings.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Treadmill training and body weight support for walking after stroke

There is not enough evidence from trials to determine the effect of treadmill training with or without body weight support for walking after stroke. An inability or an impaired ability to walk is common after stroke. Walking on a treadmill, possibly with some body weight supported via a harness connected to an overhead support system, can be used to train walking. This review found that there was not enough evidence to fully determine the effects of treadmill training. More research is needed to clarify the effects of treadmill training.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

於中風後步行時採用履帶跑步機(treadmill)訓練及體重支持(body weigh support)

合併或不合併使用安全帶給予部分體重支持的履帶跑步機訓練是中風後步行治療的一種方式。我們需要系統性地回顧以評估這種治療的花費、效果和接受度。

目標

評估履帶跑步機訓練及體重支持於中風後步行治療中個別使用或合併使用的效果。要研究的主要結果(primary outcome)是步行速度、耐久力、及依賴度。

搜尋策略

我們搜尋了Cochrane Stroke Group Trials Register (2005年3月2日最後一次搜尋)、Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2004年第4期)、MEDLINE (1966年至 2005年1月)、EMBASE (1980年至2005年2月)、CINAHL (1982 年至2005年2月)、以及PEDro (2005年3月2日最後一次搜尋)。此外，我們手工搜尋了相關研討會的會議紀錄，篩選參考文獻並與部分試驗主持人聯絡以確認進一步已發表或未發表的試驗。

選擇標準

於中風後步行治療中單獨或合併使用履帶跑步機訓練及體重支持的隨機或類似隨機對照試驗(randomised or quasirandomised trial)以及交叉試驗(crossover trial)是合乎標準的。

資料收集與分析

2位作者獨立地選擇試驗、擷取數據、並評估品質。我們與部分試驗主持人聯絡以獲得額外的資訊。我們使用?xedeffect model來分析。但是，如果結果存在著不一致性，我們就改用randomeffects model。我們分析連續變數(continuous variables)的weighted mean differences (WMD)並分析分叉變數(dichotomous variables)的相對風險(relative risk (RR))

主要結論

我們收集了包含622位受試者的15個試驗。合併或不合併體重支持的履帶跑步機訓練與其他步行速度或依賴度的介入治療之間並不存有統計上的顯著差異。於開始治療時就可以獨立行走的受試者中，履帶跑步機訓練合併體重支持有助於產生較高的步行速度(WMD 0.09 m/s, 95% con?dence interval (CI) −0.02 to 0.20 for speed; ?xedeffect)，但這個結果在統計上並沒有意義。在一個單獨試驗當中，比起單獨使用履帶跑步機訓練，這個試驗傾向於支持於無法獨立的步行者使用履帶跑步機訓練合併體重支持。在3個單獨試驗當中，有一個試驗指出，獨立的步行者可能藉由履帶跑步機訓練合併其他任務導向的運動得到好處。但是數據非常有限。在接受履帶跑步機訓練的受試者中，有害的事件比較常發生，但這些事件在臨床上並不被認為是嚴重的。

作者結論

整體而言，合併或不合併體重支持的履帶跑步機訓練，在統計上並沒有發現顯著的效果。雖然有些單獨研究建議合併體重支持的履帶跑步機訓練可能比單獨使用履帶跑步機訓練更為有效，並且建議履帶跑步機訓練加上任務導向的運動可能比假裝的運動更為有效，但需要更多的試驗來確認這些發現。

翻譯人

本摘要由奇美醫院張偉倫翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

從這些試驗當中，並沒有足夠的證據已確定合併或不合併部分體重支持的履帶跑步機訓練於中風後步行的效果。無法步行或步行能力受損在中風後是常見的。也許通過安全帶連接到天花板的支持系統給予一些體重支持於履帶跑步機上步行，可用於訓練步行。這篇回顧發現並沒有足夠的證據可以完全確定履帶跑步機訓練的效果。需要更多的研究來釐清履帶跑步機訓練的效果。

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