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Meta-Analysis
. 2015 Sep 13;2015(9):CD007830.
doi: 10.1002/14651858.CD007830.pub4.

Treadmill training for patients with Parkinson's disease

Jan Mehrholz  1 , Joachim Kugler, Alexander Storch, Marcus Pohl, Kathleen Hirsch, Bernhard Elsner
Affiliations
Meta-Analysis

Treadmill training for patients with Parkinson's disease

Jan Mehrholz et al. Cochrane Database Syst Rev. .

Abstract

Background: Treadmill training is used in rehabilitation and is described as improving gait parameters of patients with Parkinson's disease.

Objectives: To assess the effectiveness of treadmill training in improving the gait of patients with Parkinson's disease and the acceptability and safety of this type of therapy.

Search methods: We searched the Cochrane Movement Disorders Group Specialised Register (see Review Group details for more information) (last searched September 2014), Cochrane Central Register of Controlled Trials (The Cochrane Library 2014, Issue 10), MEDLINE (1950 to September 2014), and EMBASE (1980 to September 2014). We also handsearched relevant conference proceedings, searched trials and research registers, and checked reference lists (last searched September 2014). We contacted trialists, experts and researchers in the field and manufacturers of commercial devices.

Selection criteria: We included randomised controlled trials comparing treadmill training with no treadmill training in patients with Parkinson's disease.

Data collection and analysis: Two review authors independently selected trials for inclusion, assessed trial quality and extracted data. We contacted the trialists for additional information. We analysed the results as mean differences (MDs) for continuous variables and relative risk differences (RD) for dichotomous variables.

Main results: We included 18 trials (633 participants) in this update of this review. Treadmill training improved gait speed (MD = 0.09 m/s; 95% confidence interval (CI) 0.03 to 0.14; P = 0.001; I(2) = 24%; moderate quality of evidence), stride length (MD = 0.05 metres; 95% CI 0.01 to 0.09; P = 0.01; I(2) = 0%; low quality of evidence), but walking distance (MD = 48.9 metres; 95% CI -1.32 to 99.14; P = 0.06; I(2) = 91%; very low quality of evidence) and cadence did not improve (MD = 2.16 steps/minute; 95% CI -0.13 to 4.46; P = 0.07; I(2) = 28%; low quality of evidence) at the end of study. Treadmill training did not increase the risk of patients dropping out from intervention (RD = -0.02; 95% CI -0.06 to 0.02; P = 0.32; I(2) = 13%; moderate quality of evidence). Adverse events were not reported in included studies.

Authors' conclusions: This update of our systematic review provides evidence from eighteen trials with moderate to low risk of bias that the use of treadmill training in patients with PD may improve clinically relevant gait parameters such as gait speed and stride length (moderate and low quality of evidence, respectively). This apparent benefit for patients is, however, not supported by all secondary variables (e.g. cadence and walking distance). Comparing physiotherapy and treadmill training against other alternatives in the treatment of gait hypokinesia such as physiotherapy without treadmill training this type of therapy seems to be more beneficial in practice without increased risk. The gain seems small to moderate clinically relevant. However, the results must be interpreted with caution because it is not known how long these improvements may last and some studies used no intervention in the control group and underlie some risk of bias. Additionally the results were heterogenous and we found variations between the trials in patient characteristics, the duration and amount of training, and types of treadmill training applied.

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Conflict of interest statement

MP and JM were co‐authors of one included trial (Pohl 2003). They did not participate in the quality assessment and data extraction of this study.

Figures

1
1
Study flow diagram.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Funnel plot of comparison: 1 Treadmill training versus no treadmill training or active control intervention or gait training, outcome: 1.1 Gait speed at the end of the study.
4
4
Funnel plot of comparison: 1 Treadmill training versus no treadmill training or active control intervention or gait training, outcome: 1.2 stride length (at the end of study; all studies).
1.1
1.1. Analysis
Comparison 1 Treadmill training versus no treadmill training or active control intervention or gait training, Outcome 1 Gait speed at the end of the study.
1.2
1.2. Analysis
Comparison 1 Treadmill training versus no treadmill training or active control intervention or gait training, Outcome 2 stride length (at the end of study; all studies).
1.3
1.3. Analysis
Comparison 1 Treadmill training versus no treadmill training or active control intervention or gait training, Outcome 3 walking distance in m (at the end of study; all studies).
1.4
1.4. Analysis
Comparison 1 Treadmill training versus no treadmill training or active control intervention or gait training, Outcome 4 cadence (at the end of study; all studies).
1.5
1.5. Analysis
Comparison 1 Treadmill training versus no treadmill training or active control intervention or gait training, Outcome 5 acceptability and safety of treadmill training.
2.1
2.1. Analysis
Comparison 2 Sensitivity analysis: Treadmill training versus no treadmill training, Outcome 1 Gait speed.
2.2
2.2. Analysis
Comparison 2 Sensitivity analysis: Treadmill training versus no treadmill training, Outcome 2 Gait speed.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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References to studies excluded from this review

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References to other published versions of this review

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