Gesundheitswissenschaften/Public Health, Medical Faculty, Technical University of Dresden; SRH Hochschule für Gesundheit, University of Applied Health Sciences; Helios Klinik Schloss Pulsnitz.
Dtsch Arztebl Int. 2018 Sep 28;115(39):639-645. doi: 10.3238/arztebl.2018.0639.
Gait velocity and maximum walking distance are central parameters for measuring the success of rehabilitation of gait after a stroke. The goal of this study was to provide an overview of current evidence on the rehabilitation of gait after a stroke.
A systematic review of randomized, controlled trials was carried out using network meta-analysis. The primary endpoint was gait velocity; secondary end- points were the ability to walk, maximum walking distance, and gait stability. The following interventions were analyzed: no gait training, conventional gait training (reference category), training on a treadmill with or without body weight support, training on a treadmill with or without a speed paradigm, and electromechanically assisted gait training with end-effector or exoskeleton apparatus.
The systematic search yielded 40 567 hits. 95 randomized, controlled trials involving a total of 4458 post-stroke patients were included in the meta-analysis. With respect to the primary endpoint of gait velocity, gait training assisted by end- effector apparatus led to significant improvement (mean difference [MD] = 0.16 m/s; 95% confidence interval [0.04; 0.28]). None of the other interventions improved gait velocity to any significant extent. With respect to one of the secondary endpoints, maximum walking distance, both gait training assisted by end-effector apparatus and treadmill training with body weight support led to significant improvement (MD = 47 m, [4; 90], and MD = 38 m, [4; 72], respectively). A network meta-analysis could not be performed with respect to the ability to walk (a different secondary endpoint) because of substantial inconsistencies in the data. The interventions did not differ significantly with respect to safety.
In comparison to conventional gait rehabilitation, gait training assisted by end-effector apparatus leads to a statistically significant and clinically relevant improvement in gait velocity and maximum walking distance after stroke, while treadmill training with body weight support leads to a statistically significant and clinically relevant improvement in maximum walking distance.
步态速度和最大步行距离是衡量中风后步态康复成功的核心参数。本研究的目的是提供中风后步态康复的当前证据综述。
使用网络荟萃分析对随机对照试验进行系统回顾。主要终点是步态速度；次要终点是行走能力、最大步行距离和步态稳定性。分析了以下干预措施：无步态训练、常规步态训练（参照组）、带或不带体重支撑的跑步机训练、带或不带速度范式的跑步机训练、带末端效应器或外骨骼装置的机电辅助步态训练。
系统搜索产生了 40567 个结果。95 项涉及 4458 例中风后患者的随机对照试验被纳入荟萃分析。关于步态速度的主要终点，末端效应器辅助步态训练显著改善（平均差异 [MD] = 0.16 m/s；95%置信区间 [0.04；0.28]）。其他干预措施均未显著改善步态速度。关于次要终点之一的最大步行距离，末端效应器辅助步态训练和带体重支撑的跑步机训练均显著改善（MD = 47 m，[4；90]，MD = 38 m，[4；72]）。由于数据存在实质性不一致，无法进行关于行走能力（不同的次要终点）的网络荟萃分析。干预措施在安全性方面没有显著差异。
与常规步态康复相比，末端效应器辅助步态训练可显著改善中风后步态速度和最大步行距离，具有统计学意义和临床相关性，而带体重支撑的跑步机训练可显著改善最大步行距离。
