A Cochrane review [Abstract] 1 included 36 studies with a total of 1472 subjects with stroke. Electromechanical-assisted gait training in combination with physiotherapy increased the odds of becoming independent in walking (OR 1.94, 95% CI 1.39 to 2.71; 36 trials, n=1472). It did not increase walking velocity (MD = 0.04 m/sec, 95% CI 0.00 to 0.09; 24 trials, n=985) or walking capacity significantly (MD = 3 metres walked in 6 minutes, 95% CI -29 to 35; 12 trials, n=594). However, the results must be interpreted with caution because (1) some trials investigated patients who were independent in walking at study onset, (2) variations between the trials were found with respect to devices used and duration and frequency of treatment , and (3) some trials tested electromechanical devices in combination with functional electrical stimulation. The planned subgroup analysis suggests that people in the acute phase, defined as within 3 months after stroke, may benefit (OR 1.90, 95% CI 1.38 to 2.63; p<0.00001; 21 trials, n=1143) but people in the chronic phase may not benefit (OR 1.20, 95% CI 0.40 to 3.65; 16 trials, n=461) from electromechanical-assisted gait training . Post hoc analysis showed that people who are non-ambulatory at intervention onset may benefit ( OR 1.90, 95% CI 1.04 to 3.48; 12 trials, n=632) but ambulatory people may not benefit (OR 1.38, 95% CI 0.45 to 4.20; 15 trials, n=500) from this type of training. Post hoc analysis showed no differences between the types of devices used in studies regarding ability to walk, but significant differences were found between devices in terms of walking velocity.
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in interventions and outcomes).
Primary/Secondary Keywords