Electromechanical-Assisted Training for Walking After Stroke: Update of the Evidence

Electromechanical-assisted gait training uses specialist machines to assist walking practice and might help to improve walking after stroke.
Objectives
This update of our Cochrane Review examined the effects of electromechanical and robotic-assisted gait training devices for improving walking after stroke and also assessed walking velocity, walking capacity, acceptability, and death from all causes until the end of the intervention phase.
Methods
We searched the Cochrane Stroke Group Trials Register (last searched January 2020); the CENTRAL (Cochrane Central Register of Controlled Trials; 2020 Issue 1), in the Cochrane Library; MEDLINE in Ovid (1950 to January 2020); Embase (1980 to January 2020); the Cumulative Index to Nursing and Allied Health Literature (1982 to November 2019); the Allied and Complementary Medicine Database (1985 to January 2020); Web of Science (1899 to January 2020); SPORTDiscus (1949 to January 2020); the Physiotherapy Evidence Database (PEDro; searched January 2020); and the engineering databases COMPENDEX (1972 to January 2020) and Inspec (1969 to January 2020). We handsearched relevant conference proceedings, searched trials and research registers, checked reference lists, and contacted trial authors in an effort to identify further published, unpublished, and ongoing trials. Two review authors independently selected trials for inclusion, assessed methodological quality, and extracted the data. The primary outcome was the proportion of participants walking independently at follow-up; secondary outcomes were walking speed and walking capacity. We included only randomized controlled trials comparing electromechanical and robot-assisted gait training for recovery of walking function with other rehabilitation interventions or no treatment. We performed subgroup analysis comparing participants treated in the subacute phases of their stroke with participants treated in the chronic phase and also subgroup analysis comparing different devices.
Main Results
In this review update, we included 62 trials involving 2440 participants. Electromechanical-assisted gait training in combination with physiotherapy increased the odds of participants becoming independent in walking with a median intervention time of 4 weeks and a range of 1 to 12 weeks (odds ratio, 2.14 [95% CI, 1.57–2.92]; P<0.001; I2=6%; Figure), increased walking velocity (mean difference, 0.06 m/s [95% CI, 0.02–0.10]; P=0.004; I2=60%) but did not increase walking capacity (mean difference, 10.9 meters walked in 6 minutes [95% CI, −5.7 to 27.4]; P=0.2; I2=42%;). Our subgroup analysis suggests that people in the subacute phase and people who are nonambulatory may benefit from this type of training. We found differences between the types of devices regarding walking velocity and capacity.
Conclusions
Patients who receive electromechanical-assisted gait training in combination with physiotherapy after stroke are more likely to achieve independent walking than people who receive gait training with physiotherapy without these devices.
Implications for Clinical Practice and Future Research
Our findings indicate that people in the subacute phase after stroke who are not ambulatory seem to benefit most from this type of intervention. Further research should address what frequency or duration of walking training might be most effective and how long the benefit can last.