Electromechanical-assisted training for walking after stroke.
BACKGROUND
Electromechanical and robotic-assisted gait training devices are used in rehabilitation and might help to improve walking after stroke.


OBJECTIVE
To investigate the effect of automated electromechanical and robotic-assisted gait training devices for improving walking after stroke.


METHODS
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 handsearched 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and research registers, checked reference lists and contacted authors in an effort to identify further published, unpublished and ongoing trials.


METHODS
We included studies using random assignment.


METHODS
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.


RESULTS
Eight trials (414 participants) were included in this review. Electromechanical-assisted gait training in combination with physiotherapy increased the odds of becoming independent in walking (odds ratio (OR) 3.06, 95% confidence interval (CI) 1.85 to 5.06; P < 0.001), and increased walking capacity (mean difference (MD) = 34 metres walked in six minutes, 95% CI 8 to 60; P = 0.010), but did not increase walking velocity significantly (MD = 0.08 m/sec, 95% CI -0.01 to 0.17; P = 0.08). However, the results must be interpreted with caution because (1) variations between the trials were found with respect to duration and frequency of treatment and differences in ambulatory status of patients, and (2) some trials tested electromechanical devices in combination with functional electrical stimulation.


CONCLUSIONS
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. However, further research should address specific questions, for example, which frequency or duration of electromechanical-assisted gait training might be most effective and at what time after stroke, and follow-up studies are needed to find out how long the benefit lasts. Future research should include estimates of the costs (or savings) due to electromechanical gait training.
Mehrholz
J
J
Klinik Bavaria Kreischa, Department of Early Rehabilitation, An der Wolfsschlucht 1-2, Kreischa, Germany, 01731. jan.mehrholz@klinik-bavaria.de
Werner
C
C
Kugler
J
J
Pohl
M
M
D004867:Equipment Design; D005684:Gait; D006801:Humans; D009989:Orthotic Devices; D016032:Randomized Controlled Trials as Topic; D012371:Robotics / Q000295:instrumentation*; D000071939:Stroke Rehabilitation; D016138:Walking