Mehrholz Jan, Pohl Marcus, Elsner Bernhard
Wissenschaftliches Institut, Private Europäische Medizinische Akademie der Klinik Bavaria in Kreischa GmbH, An der Wolfsschlucht 1-2, Kreischa, Germany, 01731.
Cochrane Database Syst Rev. 2014 Jan 23;2014(1):CD002840. doi: 10.1002/14651858.CD002840.pub3.
Treadmill training, with or without body weight support using a harness, is used in rehabilitation and might help to improve walking after stroke. This is an update of a Cochrane review first published in 2005.
To determine if treadmill training and body weight support, individually or in combination, improve walking ability, quality of life, activities of daily living, dependency or death, and institutionalisation or death, compared with other physiotherapy gait training interventions after stroke. The secondary objective was to determine the safety and acceptability of this method of gait training.
We searched the Cochrane Stroke Group Trials Register (last searched June 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) and the Database of Reviews of Effects (DARE) (The Cochrane Library 2013, Issue 7), MEDLINE (1966 to July 2013), EMBASE (1980 to July 2013), CINAHL (1982 to June 2013), AMED (1985 to July 2013) and SPORTDiscus (1949 to June 2013). We also handsearched relevant conference proceedings and ongoing trials and research registers, screened reference lists and contacted trialists to identify further trials.
Randomised or quasi-randomised controlled and cross-over trials of treadmill training and body weight support, individually or in combination, for the treatment of walking after stroke.
Two authors independently selected trials, extracted data and assessed methodological quality. The primary outcomes investigated were walking speed, endurance and dependency.
We included 44 trials with 2658 participants in this updated review. Overall, the use of treadmill training with body weight support did not increase the chances of walking independently compared with other physiotherapy interventions (risk difference (RD) -0.00, 95% confidence interval (CI) -0.02 to 0.02; P = 0.94; I² = 0%). Overall, the use of treadmill training with body weight support in walking rehabilitation for patients after stroke increased the walking velocity and walking endurance significantly. The pooled mean difference (MD) (random-effects model) for walking velocity was 0.07 m/s (95% CI 0.01 to 0.12; P = 0.02; I² = 57%) and the pooled MD for walking endurance was 26.35 metres (95% CI 2.51 to 50.19; P = 0.03; I² = 60%). Overall, the use of treadmill training with body weight support in walking rehabilitation for patients after stroke did not increase the walking velocity and walking endurance at the end of scheduled follow-up significantly. The pooled MD (random-effects model) for walking velocity was 0.04 m/s (95% CI -0.06 to 0.14; P = 0.40; I² = 40%) and the pooled MD for walking endurance was 32.36 metres (95% CI -3.10 to 67.81; P = 0.07; I² = 63%). However, for ambulatory patients improvements in walking endurance lasted until the end of scheduled follow-up (MD 58.88 metres, 95% CI 29.10 to 88.66; P = 0.0001; I² = 0%). Adverse events and drop outs did not occur more frequently in people receiving treadmill training and these were not judged to be clinically serious events.
AUTHORS' CONCLUSIONS: Overall, people after stroke who receive treadmill training with or without body weight support are not more likely to improve their ability to walk independently compared with people after stroke not receiving treadmill training, but walking speed and walking endurance may improve. Specifically, stroke patients who are able to walk (but not people who are not able to walk) appear to benefit most from this type of intervention. This review found that improvements in walking endurance in people able to walk may have persisting beneficial effects. Further research should specifically investigate the effects of different frequencies, durations or intensities (in terms of speed increments and inclination) of treadmill training, as well as the use of handrails, in ambulatory patients, but not in dependent walkers.
跑步机训练，无论是否使用吊带提供体重支持，都用于康复治疗，可能有助于改善中风后的行走能力。这是对2005年首次发表的Cochrane系统评价的更新。
与中风后其他物理治疗步态训练干预措施相比，确定跑步机训练和体重支持单独或联合使用是否能改善行走能力、生活质量、日常生活活动能力、依赖性或死亡率以及住院或死亡率。次要目的是确定这种步态训练方法的安全性和可接受性。
我们检索了Cochrane中风组试验注册库（最后检索时间为2013年6月）、Cochrane对照试验中央注册库（CENTRAL）和效果评价数据库（DARE）（《Cochrane图书馆》2013年第7期）、MEDLINE（1966年至2013年7月）、EMBASE（1980年至2013年7月）、CINAHL（1982年至2013年6月）、AMED（1985年至2013年7月）和SPORTDiscus（1949年至2013年6月）。我们还手工检索了相关会议论文集、正在进行的试验和研究注册库，筛选了参考文献列表并联系了试验者以识别更多试验。
跑步机训练和体重支持单独或联合使用治疗中风后行走的随机或半随机对照及交叉试验。
两位作者独立选择试验、提取数据并评估方法学质量。所研究的主要结局为行走速度、耐力和依赖性。
在本次更新的系统评价中，我们纳入了44项试验，共2658名参与者。总体而言，与其他物理治疗干预措施相比，使用带体重支持的跑步机训练并未增加独立行走的机会（风险差（RD）-0.00，95%置信区间（CI）-0.02至0.02；P = 0.94；I² = 0%）。总体而言，中风后患者在行走康复中使用带体重支持的跑步机训练显著提高了行走速度和行走耐力。行走速度的合并平均差（MD）（随机效应模型）为0.07 m/s（95%CI 0.01至0.12；P = 0.02；I² = 57%），行走耐力的合并MD为26.35米（95%CI 2.51至50.19；P = 0.03；I² = 60%）。总体而言，中风后患者在行走康复中使用带体重支持的跑步机训练在预定随访结束时并未显著提高行走速度和行走耐力。行走速度的合并MD（随机效应模型）为0.04 m/s（95%CI -0.06至0.14；P = 0.40；I² = 40%），行走耐力的合并MD为32.36米（95%CI -3.10至67.81；P = 0.07；I² = 63%）。然而，对于能行走的患者，行走耐力的改善持续到预定随访结束（MD 58.88米，95%CI 29.10至88.66；P = 0.0001；I² = 0%）。接受跑步机训练的人群中不良事件和退出情况并未更频繁发生，且这些未被判定为临床严重事件。
总体而言，与未接受跑步机训练的中风患者相比，接受带或不带体重支持的跑步机训练的中风患者独立行走能力提高的可能性并未增加，但行走速度和行走耐力可能会改善。具体而言，能够行走的中风患者（而非不能行走的患者）似乎从这种干预类型中获益最大。本系统评价发现，能够行走的患者行走耐力的改善可能具有持续的有益效果。进一步的研究应具体调查跑步机训练的不同频率、持续时间或强度（就速度增加和坡度而言）以及扶手的使用对能行走患者（而非依赖步行者）的影响。
