Technology-assisted gait training (TAGT) with body weight support usually provides high repetitions of task practice.
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Evidence is insufficient to support the superiority of such TAGT over traditional training.
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The connection between repetition and intensity of training should be reconsidered.
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More direct evidence is needed to evaluate the benefit of high repetition during TAGT.
Abstract
Background
Technology-assisted gait training (TAGT) with body weight support (BWS) has been designed to provide high numbers of repetitions during stepping practice, but its benefits have been inconclusive.
Objective
We evaluated the superiority of TAGT over conventional overground training (COT) to judge the clinical benefits.
Methods
We searched PubMed, Embase and Web of Science databases from their earliest record to July 1, 2019 and included randomized controlled trials of TAGT with BWS, such as robot-assisted gait training and body weight-supported treadmill training, for treating walking disability in patients within 6 months after stroke. We conducted a meta-analysis of the outcomes motor impairment, mobility capacity, walking speed, endurance and fitness, balance, and activities of daily living as well as subgroup analyses of initial ambulatory ability and stroke duration.
Results
Among 14 robotics and 10 body weight-supported treadmill studies included for review, 23 studies involving 1452 participants contributed to the meta-analysis. We found no significant standardized mean differences between TAGT and COT (P > 0.05) across all outcome categories in the robotics subgroup, the body weight-supported treadmill subgroup, or both subgroups combined, for both the short and long term. Further subgroup analyses also revealed non-significant standardized mean differences (P > 0.05) across all outcomes in the subgroups initially ambulatory, non-ambulatory, or stroke duration less than 3 months.
Conclusions
TAGT with BWS was not superior to COT in improving post-stroke recovery in patients with subacute stroke. Strategies other than simply increasing the repetitions by external assistance may be considered to augment the treatment effects of TAGT.
