Treadmill Training in Multiple Sclerosis: Can Body Weight Support or Robot Assistance Provide Added Value? A Systematic Review

Table 3

Descriptive analysis of the included studies structured following the PICO method.

Reference.

Participants

Intervention (+Comparison)

Outcome

Results

Author (year)

Study (MQS)

Number

Male/female

EDSS score

Age

Type MS

Design

Type

Speed/BWS

Sessions

Outcome-measurements

Assessment times

Gait-related outcome measurements

Beer et al. (2008) [29]

true exp. (79%)

29 (35: 6 drop-outs; 5 in RATT and 1 in CWT)

12 m/23 f RATT: 7 m/12 f, CWT: 5 m/11 f

RATT: 6.5 (range: 6–7.5), CWT: 6.5 (range: 6–7.5)

RATT: 49.7 (SD 11), CWT: 51 (SD 15.5)

Chronic P, RR

Prospective RCT, comparing RATT with CWT

RATT: BWSTT + Lokomat (𝑛=19 → 𝑛=14), CWT: conventional walking training (𝑛=16 → 𝑛=15)

RATT: initial BWS (40–80%), assistance of leg movements (40–100%) and speed (1–1.5 kmph/0.28–0.42 m/s). ↓ BWS and assistance and ↑ speed. CWT: walking over ground with or without walking aids, with assistance.

15 sessions, 30 min, 5x/w

Walking speed (20 MWT), walking endurance (6 MWT), stride length (cm)

Baseline, after 3w and at followup after 6 m.

After RATT: sign. ↑ walking speed and endurance. After CWT: sign. ↑ walking speeds. No sign. differences between groups. Followup (𝑛=23): outcome values returned to baseline.

Vaney et al. (2011) [30]

true exp. (77%)

49 (67: 18 drop-outs)

?

RATT: 5.9 (SD 0.90, range: 3–6.5) CWT: 5.7 (SD 1.06, range: 3–6.5)

RATT: 58.2 (SD 9.42, range: 37–73) CWT: 54.2 (SD 11.28, range: 36–74),

?

RCT comparing RATT with CWT

RATT: BWSTT + Lokomat (𝑛=26), CWT: walking in group with physiotherapist (𝑛=23)

RATT: initial BWS 50%, individually adapted, speed: regulated on gait observation, initial guidance 100% and reduced as much as possible. CWT: in gym room or outside on uneven ground + walking aids.

RATT: 6 to 10 (mean 9) sessions, CWT: 7 to 10 (mean 8) sessions. 30 min.

Walking speed (10 MWT, 3 MWT on 80 m hallway)

Baseline, after treatment.

In both groups: ↑ walking speed. No sign. between-group differences. sign. ↑ walking speed, between group difference was in favor of the CWT.

Schwartz et al. (2011) [31]

true exp. (77%)

28 (32: 4 drop outs; 1 in CWT, 3 in RATT) Follow-up 3 m 𝑛=24, 6 m 𝑛=18

14 m/18 f RATT: 7 m/8 f, CWT: 7 m/10 f

RATT: 6.2 (SD 0.5, range: 5.5–7), CWT: 6 (SD 0.6, range: 5–7)

RATT: 46.8 (SD 11.5, range: 29–69), CWT: 50.5 (SD 11.5, range: 28–70)

RP, SP, PP

Prospective RCT

RATT: BWSTT + Lokomat (𝑛=15), CWT: gait and dynamic balance exercises, standing from sitting training and walking with or without walking aids (𝑛=17).

RATT: initial BWS: 40%, after 2 w 30%, after 4 w 20%. speed: maximum speed tolerated.

12 sessions, 30 min, 2–3x/w for 4 w

Walking speed (10 MWT), walking endurance (6 MWT), disability (EDSS)

Baseline, after 4 w, followup after 3 and 6 m.

After CWT: sign.↑ walking endurance and speed and ↓ EDSS. After RATT: no sign. ↑ walking endurance and speed, sign. ↓ EDSS. Followup: outcome values returned to baseline.

Lo and Triche (2008) [32]

true exp. (71%)

13

7 m/6 f

4.9 (SD 1.2)

49.8 (SD 11.1)

RR SP (𝑛=8), PP (𝑛=5)

prospective randomized pilot study, randomized cross-over design, RATT-BWSTT (𝑛=6), BWSTT-RATT (𝑛=7)

(1) BWSTT followed by BWSTT + Lokomat or (2) BWSTT + Lokomat followed by BWSTT. After 1st phase (T2), 6-week washout period (T3), crossed-over to the alternate treatment.

Initial BWS: 30% to 40%, initial speed: 1.5 kmph (0.42 m/s). ↑ speed to 2.2 to 2.5 kmph (0.61 to 0.69 m/s) before ↓ BWS

12 sessions (6/phase), 40 min, 2x/w

Walking speed (T25 FW), walking endurance (6 MWT on treadmill), disability (EDSS)

T1 (baseline), T2 (after first phase, 3 w), T4 (end study, 12 w)

↑ walking speed, ↑ walking endurance (𝑛=12), ↓ double limb support time (𝑛=12). ↓ EDSS. No sign. differences due to treatment order.

van den Berg et al. (2006) [33]

true exp. (62.5%)

16 (19: 3 drop outs)

3 m/13 f

? (able to walk 10 m (using aids if required) in less than 60 s + could walk safely on treadmill without therapist or BW support.

IT: 30–65, DT: 30–65

?

RCT, pilot study (random.) cross over design.

TT, IT: training-no training (𝑛=8); DT: no training-training (𝑛=8).

Walking duration ↑ as tolerated, up to max 30 min with a max of 3 rest periods. Once max walking duration was attained, intensity ↑ by ↑ speed. Encouraged: 55–85% of age-predicted max HR.

12 sessions, 30 min, 3x/w

Walking speed (10 MWT), walking endurance (2 MWT)

Baseline, week 7 (T1) and 12 (T2)

At T1: ↑ walking endurance; trained group sign. ↑ walking speed compared to untrained group. At T2: walking performance returned toward baseline scores.

Newman et al. (2007) [34]

pre-exp. (56%)

53.6 (SD 8.67, range: 30–65)

RT, repeated measures trial with blinded assessments

TT

At 55–85% of age-predicted max HR. Speed ↑ as directed by participants once able to walk for 30 min continuously.

Cadence, gait cycle time, foot contact time, and stride length (Gait-Rite mat), walking speed (10 MWT), and walking endurance (2 MWT)

Baseline and after 4 w

Sign. ↑ walking speed and endurance. Weak leg sign. ↑ swingphase time and ↓ standphase time. Strong leg sign. ↑ stride length.

Pilutti et al. (2011) [35]

pre-exp. (54%)

6

2 m/4 f

6.9 (SD 1.07) range: 5.5–8.0

48.2 (SD: 9.3)

PP (𝑛=5), SP (𝑛=1)

Before-after trial

BWSTT

Baseline: 1.1±0.10 kmph (0.31 m/s) with 77.9%  ± 10.76% BWS. During training ↑speed and endurance and ↓BWS

36 sessions, 30 min, 3x/w

Walking speed (T25 FW), disability (EDSS)

Baseline, after 12 w

↓0.5 EDSS (𝑛=1), ↑ walking speed.

Giesser et al. (2007) [36]

pre-exp. (48%)

4

1 m/3 f

7.0–7.5

42, 44, 48, 54

SP

Case series, intervention study

BWSTT + 3 trainers each subjects (1 left leg, 1 right leg, 1 trunk/pelvis)

Initially: BWS at maximum level (knee buckling and trunk collapse can be avoided during stepping). BWS ↓ if able to support their weight during stepping at normal speeds (0.85–1.03 m/s)

39, 40, 42, 42 sessions, 2x/w

Disability (EDSS), walking speed (10 MWT), walking endurance (6 MWT)

Baseline and after training

↓ EDSS (𝑛=1), ↑ walking speed (𝑛=4), could not walk before and complete 10 m after (𝑛=1), ↑ walking endurance (𝑛=3), could not walk before and complete 6 min after (𝑛=2).

exp.: experimental design, MQS: methodological quality score, RATT: robot-assisted gait training, CWT: conventional walking therapy, SD: standard deviation, IT: immediate training, DT: delayed training, PP: primary progressive, SP: secondary progressive, RR: relapsing remitting, P: progressive, RT: randomized trial, BWS: body weight support, RCT: randomized controlled trial, BWS: body-weight support, HR: heart rate, sign.: significant, EDSS: expanded disability status scale, T-25 FW: timed 25-foot walk, 6 MWT: six-minute walk test, 2 MWT: two-minute walk test, three MWT: three-minute walk test, 20 MWT: twenty-meter walk test, 10 MWT: ten-meter walk test, Sign.: significant, ↑: increase, ↓: decrease.