Mehrholz J, Thomas S, Kugler J, PohlM, Elsner B. Electromechanical-assisted training for walking after stroke. Cochrane Database of Systematic Reviews 2020, Issue 10. Art. No.: CD006185. DOI: 10.1002/14651858.CD006185.pub5.
Study aim/ objective:
This study is an update of a Cochrane Review first published in 2007 and previously updated in 2017. The primary objective was to determine whether electromechanical and robot assisted gait training versus normal care improves walking after stroke, secondary objectives were also considered, these were to determine whether electromechanical and robot assisted gait training versus normal care after stroke improves walking velocity, walking capacity, acceptability, and death from all causes until the end of the intervention phase.
Method:
- Systematic review and Meta-Analysis
- The databases searched were Cochrane Stroke Group Trials Register (the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL; AMED; Web of Science); SPORTDiscus PEDro; and the engineering databases COMPENDEX 2020) and Inspec
- Relevant conference proceedings, searched trials and research registers, reference lists, and trial authors were also contacted and searched for/through
- RCT and RCT Cross over trials included
- Studies included anyone over 18 who had had a stroke
- Two review authors independently selected trials for inclusion inclusion, assessed methodological quality and risk of bias, and extracted data.
- A third review author was used to settle any disagreements.
- Quality of evidence was assessed using the GRADE approach.
Results/Findings:
62 trials involving 2440 participants were included (average age was 47- 76 years), these were people who had had a stroke and were learning to walk again. The studies included looked at physiotherapy plus electromechanical and robotic devices for gait training versus physiotherapy alone or usual care .The results showed that using electromechanical and robotic devices for gait training:
- Helped more people walk independently (38 studies; 1567 people);
- May have increased people’s average walking speed (42 studies; 1600 people);
- Probably did not increase how far people could walk in six minutes (24 studies; 983 people); and
- Probably did not increase how many people dropped out of the study, or how many people died (62 studies; 2440 people).
For every eight people treated with a device plus physiotherapy, one extra person could walk independently by the end of treatment.
Discussion around Critique of the Paper:
- Very thorough research methods
- Local population for UHD is likely to be older
- No definition of what walking independently is, is this with an aid (stick etc.) or completely unaided – it was felt that independently would refer to not need assistance for another person.
- Difficult to rerun searches as only mesh terms including in supplementary data, not the search history
- It would have been interesting to know whether length of stay, discharge location or perceived quality of life were changed
- High level of heterogeneity in the papers chosen
- Possibility of performance bias as therapist/participants cannot be blinded.
Clinical Relevance/ Will this change the team’s practice?
The team will shortly be getting a walkerbot for the stroke unit so the paper was very useful to highlight the benefits. During the discussion it was felt that as well as an increase in those that could walk independently it could also help with motivation to do therapy, reduce costs for care after discharge and reduce the number of therapists needed to help physically get a patient walking. It was also stated that not every patient would be eligible or would benefit by using the machine. The discussion then continued into planning a UHD study on the subject once the walkerbot was in place and being used.
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