Effect of Treadmill Training Interventions on Spatiotemporal Gait Parameters in Older Adults with Neurological Disorders: Systematic Review and Meta-Analysis of Randomized Controlled Trials

Alka Bishnoi, Rachel Lee, Yang Hu, Jeannette R Mahoney, Manuel E Hernandez, Alka Bishnoi, Rachel Lee, Yang Hu, Jeannette R Mahoney, Manuel E Hernandez

Abstract

Objective: Treadmill interventions have been shown to promote ‘normal’ walking patterns, as they facilitate the proper movement and timing of the lower limbs. However, prior reviews have not examined which intervention provides the most effective treatment of specific gait impairments in neurological populations. The objective of this systematic review was to review and quantify the changes in gait after treadmill interventions in adults with neurological disorders. Data Sources: A keyword search was performed in four databases: PubMed, CINAHL, Scopus, and Web of Science (January 2000−December 2021). We performed the search algorithm including all possible combinations of keywords. Full-text articles were examined further using forward/backward search methods. Study Selection: Studies were thoroughly screened using the following inclusion criteria: study design: Randomized Controlled Trial (RCT); adults ≥55 years old with a neurological disorder; treadmill intervention; spatiotemporal gait characteristics; and language: English. Data Extraction: A standardized data extraction form was used to collect the following methodological outcome variables from each of the included studies: author, year, population, age, sample size, and spatiotemporal gait parameters including stride length, stride time, step length, step width, step time, stance time, swing time, single support time, double support time, or cadence. Data Synthesis: We found a total of 32 studies to be included in our systematic review through keyword search, out of which 19 studies included adults with stroke and 13 studies included adults with PD. We included 22 out of 32 studies in our meta-analysis that examined gait in adults with neurological disorders, which only yielded studies including Parkinson’s disease (PD) and stroke patients. A meta-analysis was performed among trials presenting with similar characteristics, including study population and outcome measure. If heterogeneity was >50% (denoted by I2), random plot analysis was used, otherwise, a fixed plot analysis was performed. All analyses used effect sizes and standard errors and a p < 0.05 threshold was considered statistically significant (denoted by *). Overall, the effect of treadmill intervention on cadence (z = 6.24 *, I2 = 11.5%) and step length (z = 2.25 *, I2 = 74.3%) in adults with stroke was significant. We also found a significant effect of treadmill intervention on paretic step length (z = 2.34 *, I2 = 0%) and stride length (z = 6.09 *, I2 = 45.5%). For the active control group, including adults with PD, we found that overground physical therapy training had the largest effect on step width (z = −3.75 *, I2 = 0%). Additionally, for PD adults in treadmill intervention studies, we found the largest significant effect was on step length (z = 2.73 *, I2 = 74.2%) and stride length (z = −2.54 *, I2 = 96.8%). Conclusion: Treadmill intervention with sensory stimulation and body weight support treadmill training were shown to have the largest effect on step length in adults with PD and stroke.

Keywords: gait; intervention; neurological disorders; treadmill.

Conflict of interest statement

J.R.M. has a financial interest in JET Worldwide Enterprises Inc., a digital health startup spun out of research conducted at Albert Einstein College of Medicine. All other authors have no conflicts of interest to report.

Figures

Figure 1
Figure 1
Study selection flow chart.
Figure 2
Figure 2
Forest plot of stroke: (A) cadence; (B) step length; (C) step length paretic; (D) stride length. Note: *—random effect model; °—fixed effect model. Abbreviations: TT: treadmill training, BWSTT: body weight support treadmill training, SpTT: speed treadmill training, IncTT: incline treadmill training, TT + VC: treadmill training with visual cues, TT + VR: treadmill training with virtual reality cues, TT + RAS: treadmill training with rhythmic auditory stimulation.
Figure 3
Figure 3
Forest plot of Parkinson’s disease: (A) stride length; (B) step length; (C) step width. Note: *—random effect model; °—fixed effect model. Abbreviations: TT: treadmill training, BWSTT: body weight support treadmill training, TT + (C path): treadmill training with a curved path, SpTT: speed treadmill training, IncTT: incline treadmill training, TT + VC: treadmill training with visual cues, TT + AC: treadmill training with auditory cues, TT + 5% L: treadmill training with 5% load, TT + 10% L: treadmill training with 10% load, TT + P: treadmill training with perturbations.
Figure 4
Figure 4
Funnel plot of Parkinson’s disease population—stride length (A), and stroke population—cadence (B).

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