Stroke. 2008;39:1929-1930
Published online before print April 3, 2008,
doi: 10.1161/STROKEAHA.107.505909
(Stroke. 2008;39:1929.)
© 2008 American Heart Association, Inc.
Electromechanical-Assisted Gait Training With Physiotherapy May Improve Walking After Stroke
Jan Mehrholz, DrPH;
Cordula Werner, PhD;
Joachim Kugler, MD
Marcus Pohl, MD
From the Department of Rehabilitation (M.P., J.M.), Klinik Bavaria Kreischa; Department of Public Health (J.K., J.M.), Faculty of Medicine TU Dresden; Department of Neurology, Klinik Berlin (C.W.), Germany.
Correspondence to Jan Mehrholz, Klinik Bavaria Kreischa An der Wolfsschlucht 1-2, Kreischa 01731, Germany. E-mail jan.mehrholz{at}klinik-bavaria.de
Graeme J. Hankey MD, FRCP Section Editor:
Key Words: gait • rehabilitation • stroke • training
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Introduction
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Many patients after stroke have difficulties with walking, and
improving walking is one of the main goals of rehabilitation.
Electromechanical and robotic-assisted gait training devices
are used in rehabilitation and might help to restore walking
after stroke.
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Objectives
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This systematic review examined the effectiveness of automated
electromechanical and robotic-assisted gait training devices
for improving walking after stroke.
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Methods
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We searched the Cochrane Stroke Group Trials Register (last
searched September 2006), the Cochrane Central Register of Controlled
Trials (CENTRAL) (The Cochrane Library, Issue 3, 2006), MEDLINE
(1966 to September 2006), EMBASE (1980 to September 2006), CINAHL
(1982 to October 2006), AMED (1985 to October 2006), SPORTDiscus
(1949 to August 2006), the Physiotherapy Evidence Database (PEDro,
searched September 2006) and the engineering databases COMPENDEX
(1972 to October 2006), and INSPEC (1969 to October 2006). We
manually searched 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unpublished, and ongoing trials.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 trial quality and extracted
the data. The primary outcome was the proportion of patients
walking independently (without assistance or help of a person)
at follow-up. To minimize bias we included only randomized controlled
trials.
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Results
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We included 8 randomized controlled trials with 414 participants.
Electromechanical-assisted gait training in combination with
physiotherapy increased the odds of becoming independent in
walking (
Figure; OR, 3.06; 95% CI, 1.85 to 5.06;
P<0.001)
and increased walking capacity (mean difference=34 meters walked
in 6 minutes; 95% CI, 8 to 60;
P=0.010), but did not increase
walking velocity significantly (mean difference=0.08 meters
per second; 95% CI, –0.01 to 0.17;
P=0.08). We used the
primary outcome of recovery of independent walking at the end
of intervention phase for all included patients (OR, 3.06) to
calculate a number needed to treat of 4 (95% CI, 3 to 5).
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Conclusions
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Patients who receive electromechanical-assisted gait training
in combination with physiotherapy after stroke are more likely
to achieve independent walking than patients receiving gait
training without these devices.
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Implications for Clinical Practice and Future Research
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This review provides evidence that the use of electromechanical-
assisted gait training devices in combination with physiotherapy
increases the chance of regaining independent walking ability
for patients after stroke. The results could be interpreted
as preventing 1 patient remaining dependent in walking after
stroke for every 4 (95% CI, 3 to 5) treated. This apparent benefit
for patients is, however, not supported by all secondary variables.
Further research should include estimates of the costs (or savings) attributable to electromechanical gait training, should compare different devices, and should address specific questions, for example, how long the benefit lasts. Full details and all graphical plots are available in the version of this review published in the Cochrane Library.1
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Acknowledgments
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Disclosures
None.
Received October 5, 2007;
accepted October 11, 2007.
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Reference
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1. Mehrholz J, Werner C, Kugler J, Pohl M. Electromechanical-assisted training for walking after stroke.
Cochrane Database Syst Rev. 2007; 4: CD006185. DOI: 10.1002/14651858.CD006185.
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Introduction
Objectives