Electromechanical-assisted training for walking after stroke updated evidence

Background
Improving walking after stroke is one of the main goals of rehabilitation. Electromechanical-assisted gait training uses specialist machines to assist walking practice and might help to improve walking after stroke.
Objectives
Our systematic review examined the effects of electromechanical and robotic-assisted gait training devices for improving walking after stroke and also assessed the acceptability and safety of this type of therapy.
Methods
We searched the Cochrane Stroke Group Trials Register (last searched April 2012), the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library 2012, Issue 2), MEDLINE (1966 to November 2012), EMBASE (1980 to November 2012), CINAHL (1982 to November 2012), AMED (1985 to November 2012), SPORTDiscus (1949 to September 2012), the Physiotherapy Evidence Database (PEDro, searched November 2012), and the engineering databases COMPENDEX (1972 to November 2012) and INSPEC (1969 to November 2012). We also handsearched relevant conference proceedings, searched trials and research registers, checked reference lists, and contacted authors in an effort to identify further published, unpublished, and ongoing trials.Two review authors independently selected trials for inclusion, assessed methodological quality, and extracted the data.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.
Main Results
In this updated review, we included 23 trials involving 999 participants. Electromechanical-assisted gait training in combination with physiotherapy increased the odds of participants becoming independent in walking (odds ratio [OR], 2.39; 95% confidence interval [CI], 1.67–3.43; P<0.00001; Figure) but did not significantly increase walking velocity (mean difference [MD], 0.04 m/s; 95% CI, 0.03–0.11; P=0.26) or walking capacity (MD, 3 metres walked in 6 minutes; 95% CI, 29–35; P=0.86). Our subgroup analysis suggests that people in the acute phase may benefit and people who are nonambulatory may benefit from this type of training. We found no differences between the types of devices regarding ability to walk, but found significant differences between devices in terms of walking velocity.
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 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.
This article is based on a Cochrane Review published in The Cochrane Library 2013, Issue 7 (see www.thecochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and The Cochrane Library should be consulted for the most recent version of the review.1