Treadmill training for patients with Parkinson Disease. An abridged version of a Cochrane Review

INTRODUCTION: Treadmill training is used in rehabilitation might improve gait parameters of patients with Parkinson Disease. Aim of this study was to assess the effectiveness of treadmill training in improving the gait of patients with Parkinson Disease and the acceptability and safety of this type of therapy. EVIDENCE ACQUISITION: We searched the Cochrane Movement Disorders Group Specialized Register (last searched September 2014), Cochrane Central Register of Controlled Trials (The Cochrane Library 2014, Issue 10), MEDLINE (1950 to September 2014), and EMBASE (1980 to September 2014). We also handsearched relevant conference proceedings, searched trials and research registers, and checked reference lists (last searched September 2014). We contacted trialists, experts and researchers in the field and manufacturers of commercial devices. We included all randomized controlled trials comparing treadmill training with no treadmill training in patients with Parkinson Disease. Two review authors independently selected trials for inclusion, assessed trial quality and extracted data. EVIDENCE SYNTHESIS: Treadmill training improved gait speed (MD=0.09 m/s; 95% confidence interval (CI) 0.03 to 0.14; P=0.001; I2=24%; moderate quality of evidence), stride length (MD=0.05 meters; 95% CI 0.01 to 0.09; P=0.01; I2=0%; low quality of evidence), but walking distance (MD=48.9 meters; 95% CI -1.32 to 99.14; P=0.06; I2=91%; very low quality of evidence) and cadence did not improve (MD=2.16 steps/minute; 95% CI -0.13 to 4.46; P=0.07; I2=28%; low quality of evidence) at the end of study. Treadmill training did not increase the risk of patients dropping out from intervention (RD=-0.02; 95% CI -0.06 to 0.02; P=0.32; I2=13%; moderate quality of evidence) and adverse events were not reported. CONCLUSIONS: This systematic review provides evidence from eighteen trials with moderate to low risk of bias that the use of treadmill training in patients with PD may improve clinically relevant gait parameters such as gait speed and stride length. This apparent benefit for patients is, however, not supported by all secondary variables (e.g. cadence and walking distance). The results must be interpreted with caution because the results were heterogeneous and it is not known how long improvements last and differences between the trials in terms of patient characteristics, duration and amount of training and types of treadmill training exists.