Treadmill training is effective for ambulatory adults with stroke : a systematic review

Question: Does mechanically assisted walking increase walking speed or distance in ambulatory people with stroke compared with no intervention/non-walking intervention, or with overground walking? Design: Systematic review with meta-analysis of randomised trials. Participants: Ambulatory adults with stroke. Intervention: Mechanically assisted walking (treadmill or gait trainer) without body weight support. Outcome measures: Walking speed measured in m/s during the 10-m Walk Test and walking distance measured in m during the 6-min Walk Test. Results: Nine studies of treadmill training comprising 977 participants were included. Treadmill training resulted in faster walking than no intervention/non-walking intervention immediately after the intervention period (MD 0.14. m/s, 95% CI 0.09 to 0.19) and this was maintained beyond the intervention period (MD -0.12. m/s, 95% CI 0.08 to 0.17). It also resulted in greater walking distance immediately after the intervention period (MD 40. m, 95% CI 27 to 53) and this was also maintained beyond the intervention period (MD 40. m, 95% CI 24 to 55). There was no immediate, statistically significant difference between treadmill training and overground training in terms of walking speed (MD 0.05. m/s, 95% CI 0.12 to 0.21) or distance (MD -6. m, 95% CI -45 to 33). Conclusion: This systematic review provides evidence that, for people with stroke who can walk, treadmill training without body weight support results in faster walking speed and greater distance than no intervention/ non-walking intervention and the benefit is maintained beyond the training period.8 page(s

Cyclical electrical stimulation increases strength and improves activity after stroke: a systematic review

Question: Does electrical stimulation increase strength after stroke and are any benefits maintained beyond the intervention period or carried over to activity? Design: Systematic review with meta-analysis of randomised or controlled trials. Participants: Adults who have had a stroke. Intervention: Cyclical electrical stimulation applied in order to increase muscle strength. Outcome measures: Strength measures had to be representative of maximum voluntary contraction and were obtained as continuous measures of force or torque, or ordinal measures such as manual muscle tests. Activity was measured using direct measures of performance that produced continuous or ordinal data, or with scales that produced ordinal data. Results: Sixteen trials representing 17 relevant comparisons were included in this systematic review. Effect sizes were calculated as standardised mean differences because various muscles were studied and different outcome measures were used. Overall, electrical stimulation increased strength by a standardised mean difference (SMD) of 0.47 (95% CI 0.26 to 0.68) and this effect was maintained beyond the intervention period (SMD 0.33, 95% CI 0.07 to 0.60). Electrical stimulation also improved activity (SMD 0.30, 95% CI 0.05 to 0.56) and this effect was also maintained beyond the intervention period (SMD 0.38, 95% CI 0.09 to 0.66). Conclusion: Cyclical electrical stimulation increases strength and improves activity after stroke. These benefits were maintained beyond the intervention period with a small-to-moderate effect size. The sustained effect on activity suggests that the benefits were incorporated into daily life. Review registration: PROSPERO (CRD42013003895). [Nascimento LR, Michaelsen SM, Ada L, Polese JC, Teixeira-Salmela LF (2014) Cyclical electrical stimulation increases strength and improves activity after stroke: a systematic review. Journal of Physiotherapy 60: 22–30