Effectiveness of Treadmill Training Intervention for the Management of Patients With Stroke: A Systematic Review and Meta-Analysis.

BACKGROUND

Treadmill training, including body weight-supported treadmill training (BWSTT), is widely used in stroke rehabilitation. However, its efficacy in improving walking outcomes may vary depending on patients' baseline functional status.

OBJECTIVE

This study aims to systematically evaluate effectiveness of treadmill training on walking speed and endurance in stroke survivors and to assess influence of baseline dependency and use of BWSTT.

METHODS

We performed systematic review and meta-analysis as per PRISMA 2020 guidelines. Comprehensive search was conducted using Scopus, MEDLINE, EMBASE, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Cochrane Library, Google Scholar and ScienceDirect for studies published from January 1964 to April 2024. Eligible studies were randomized controlled trials assessing treadmill training in stroke patients with outcomes as walking speed and/or endurance. Data extraction and risk of bias assessment were independently performed by two reviewers using Cochrane Risk of Bias-2 tool. Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated using random effects model. Subgroup analyses were conducted based on baseline dependency and BWSTT use.

RESULTS

Fifty-nine studies were included. Meta-analysis demonstrated significant improvements in walking speed (SMD = 0.255; 95%CI: 0.141-0.369) and walking endurance (SMD = 0.277; 95%CI: 0.134-0.421) among stroke survivors receiving treadmill training. Subgroup analysis revealed that independent participants experienced greater benefits in walking speed (SMD = 0.345) and endurance (SMD = 0.374) compared to dependent participants. Studies employing BWSTT reported enhanced outcomes relative to those without BWSTT. Moderate to high heterogeneity was observed, and publication bias was detected.

CONCLUSION

Treadmill training, particularly when combined with BWSTT, effectively enhances walking speed and endurance in stroke survivors.