Gait Speed Changes in Stroke Rehabilitation Motor Lower Extremity Randomized Controlled Trials by Intervention and Time Post-Stroke: A Meta-Analysis.

Abstract

To examine gait speed changes in randomized controlled trials (RCTs) of motor lower extremity (LE) stroke rehabilitation across various interventions, compared to conventional care or sham controls, at different time points post-stroke. A meta-analysis was conducted, in accordance with PRISMA guidelines. Systematic searches in MEDLINE, Embase, CINAHL and PsycINFO, were conducted for RCTs published in English, up to December 2024. RCTs were included if they examined a LE motor rehabilitation intervention in adults with stroke, used conventional care or sham as control group, and evaluated gait speed. Two independent reviewers performed the screening of title/abstract, full-text screening and data extraction, with an independent reviewer available for conflict resolution. A total of 106 RCTs met the inclusion criteria; 63.2% were conducted in the chronic phase post-stroke. Five interventions were evaluated in both the acute/subacute and chronic phases, of which, three, treadmill training, body weight-supported treadmill training, and training with exoskeletons, showed significant benefits in the acute/subacute phases, compared to conventional care, however, none showed any significant benefit in the chronic phase. Of the interventions evaluated solely in the chronic phase, overground walking training, trunk training, mirror therapy, and virtual reality demonstrated significant benefits compared to conventional care. Interventions studied during the acute/subacute phases post-stroke demonstrated significantly greater magnitude of improvement in gait speed compared to those in the chronic phase. Overall, interventions for LE motor function post stroke evaluated in the acute/subacute phase demonstrated a greater magnitude of effect on gait speed compared to those assessed in the chronic phase, although more RCTs are being conducted in the chronic phase.