80
Outcomes of this review were reported in correspondence
with the proposed research questions. This firstly includes a
description of therapeutic strategies allowing non-ambulant
stroke patients to repetitively train walking. Secondly, the 2
feasibility items safety, measured by the incidence of adverse
events, and adherence to therapy, defined as the number of
drop-outs, were investigated. Thirdly, outcomes on effectiveness
were investigated and classified according to the domains of
the International Classification of Functioning Disability and
Health (ICF) model (32). All included studies had to include the
ability to walk independently (primary outcome) as an outcome
measure. Secondary gait-related outcomes were included, such
as motor impairments of the affected leg and different measures
on walking performance. main interventions, body weight supported treadmill
training (BWSTT) and robot-assisted gait training
(RAGT), in other databases (Cochrane Library, Rehab
Data, PEDro) the reviewers searched explicitly for
those interventions. After de-duplication and a first
phase screening on eligibility, 132 unique studies were
included for detailed screening on abstract and after-
wards on full-text. Finally, 15 studies were included
(see Fig. 1). A revision in August 2018 did not reveal
additional eligible studies.
Quantitative analysis In the final screening phase, 4 studies were excluded
due to insufficient quality. Of the remaining 15 studies,
9 presented good (PEDro score 8 (35–37); 7 (38–41))
and 6 moderate quality (PEDro score 6 (42–47); 5
(48, 49)) (see Table II). A detailed scoring is shown
in Table SII 1 .
Review Manager software (RevMan 5.3) was used for the quan-
titative synthesis on the comparative effectiveness. Therefore, the
number of participants in both groups together with the means
of post-intervention and follow-up scores and its standard de-
viations were entered in RevMan 5.3 by one reviewer (JS) and
cross-checked by another reviewer (WS or ST). If the scores
were provided in medians and interquartile ranges, an algorithm
developed by Wan et al. (33) was used to estimate means and
standard deviations. Summary effect sizes (SES) were calculated
with 95% confidence interval (95% CI) based on the effect sizes
of individual studies. The mean differences (MD) were calcu-
lated since identical measures were used per comparison. When
dichotomized outcome on walking independence was reported,
an odds ratio was additionally calculated. The I 2 statistic was
used to determine between-study heterogeneity in results. If
heterogeneity was high (I 2 > 50%) a random-effects model was
used. In each comparison, a sub-analysis on the intervention type
was performed. If at least 3 RCTs could be included in a sub-
group, the results were reported separately. In addition, if results
of 2 or more subgroups were given, the subgroup difference was
established using a χ 2 test. Finally, the level of evidence drawn
from the quantitative analysis were graded using a classification
adapted from the Scottish Intercollegiate Guideline Network
(SIGN) guidelines (34), where the methodological quality of
included RCTs and consistency of results (based on the I 2 test for
heterogeneity) will be taken into account (see Table I).
Methodological quality
Outcomes
In the 15 studies, a total of 915 participants were treated
and evaluated: RAGT was provided to 286 participants
and BWSTT to 152 participants, while 425 participants
were allocated to the control groups.
PubMed 330
Web of Science 464
PEDro 42
RehabData 14
Cochrane Lib 31
Potentially relevant
citations identified: 881
Potentially relevant
citations identified: 132
1. de-duplication &
titel/abstract
evaluation, citations
excluded:
749
2. detailed titel/
abstract evaluation,
citations excluded: 78
Reasons:
RESULTS
Literature search
In PubMed, the search strategy (see Table SI 1 ) led to
330 hits on 24 October 2017 and a similar strategy
was used in Web of Science. After identifying the 2
Citations retrieved for
more detailed
evaluation:
B
C
D
RCT: randomized controlled trial.
www.medicaljournals.se/jrm
5
S (no RCT) 20
53
54
3. Full text
evaluation, citations
excluded:
39
Reasons:
Conclusion based on …
At least 3 RCTs with a low risk of bias with consistent results and a
clinical meaningful effect.
At least 2 RCTs with a low risk of bias but inconsistent results, or at
least 2 RCTs with a moderate risk of bias with consistent results.
One RCT with a low risk of bias, or several RCTs with a moderate risk of
bias with inconsistent results.
Lower.
P (chronic)
I (no gait training)
Table I. Rating the level of evidence adapted from the Scottish
Intercollegiate Guideline Network (SIGN) guidelines
A
J. Schröder et al.
P (>1mo post) 11
I (no gait training) 12
P (FAC >3)
S (no RCT)
S (PEDro 4)
Relevant citations:
8
4
4
15
Fig. 1. Flow diagram of study identification and selection process. P:
participants; I: intervention; S: study design.