Clinical non-superiority of technology-assisted gait training with body weight support in patients with subacute stroke: A meta-analysis

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.