A Cochrane review [Abstract] 1 included 56 studies with a total of 3105 patients. The average age was 60 years, and the studies were carried out in both inpatient and outpatient settings. All patients had at least some walking difficulties. The comparisons were treadmill training (TT) with body weight support to other physiotherapy intervention (26 studies, n=1410),without body weight support to other physiotherapy intervention, no intervention or sham therapy(20 studies, n=889), TT with body weight support to TT without body weight support (2 studies, n=100), and 4 studies (n=147) did not state whether they used body weight support.Overall, the use of TT did not increase the chances of walking independently compared with other physiotherapy interventions (risk difference (RD) -0.00, 95% CI -0.02 to 0.02; 18 trials, n=1210). The use of TT in walking rehabilitation for patients after stroke increased the walking velocity and walking endurance significantly (pooled MD for walking velocity was 0.06 m/s, 95% CI 0.03 to 0.09; 47 trials, n=2323) and the pooled MD for walking endurance was 14.19 metres (95% CI 2.92 to 25.46; 28 trials, n=1680). However, the use of TT with body weight support in walking rehabilitation did not increase the walking velocity and walking endurance at the end of scheduled follow-up significantly (pooled MD for walking velocity was 0.03 m/s, 95% CI -0.05 to 0.10; 12 trials, n=954) and the pooled MD for walking endurance was 21.64 metres (95% CI -4.70 to 47.98; 10 trials, n=882). However, for ambulatory patients improvements in walking endurance lasted until the end of scheduled follow-up, pooled MD for walking velocity was 0.08 m/s (95% CI 0.05 to 0.12; 38 trials, n=1571). Adverse events and drop outs did not occur more frequently in people receiving treadmill training.
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in patients and interventions) and by indirectness (differences in studied patients, e.g. time post-stroke at recruitment, some studies had no active control group or compared with no intervention).
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