Body weight-supported gait training for patients with spinal cord injury: a network meta-analysis of randomised controlled trials

Abstract

Different body weight-supported gait-training strategies are available for improving ambulation in individuals with spinal cord injury (SCI). These include body weight-supported overground training (BWSOGT), body weight-supported treadmill training (BWSTT), and robot-assisted gait training (RAGT). We conducted a network meta-analysis of randomised controlled trials (RCTs) to assess the effect and priority of each training protocol. We searched the PubMed, Cochrane Library, Scopus, and Embase databases from inception to 6 August 2022. The eligibility criteria were as follows: (1) being RCTs, (2) recruiting participants with SCI diagnosis and requiring gait training, (3) comparing different body weight-supported gait training strategies, and (4) involving ambulatory assessments. We conducted a network meta-analysis to compare different training strategies using the standard mean difference and its 95% credible interval. To rank the efficacy of training strategies, we used the P score as an indicator. Inconsistency in network meta-analysis was evaluated using loop-specific heterogeneity. We included 15 RCTs in this analysis. RAGT was had significantly more favourable performance than had the control intervention. The ranking probabilities indicated that the most effective approach was RAGT, followed by BWSOGT, BWSTT, and the control intervention. No significant inconsistency was noted between the results of the direct and indirect comparisons.

Figure 1

Flowchart of study selection.

Figure 2

Study quality assessment.

Figure 3

Network plot of all studies. The nodes, which represent the interventions in the network, and the lines, which highlight the available direct comparisons between pairs of interventions. The size of the nodes and the width of the lines both represent the number of studies. RAGT, robot-assisted gait training; BWSTT, body weight-supported treadmill training; BWSOGT, body weight-supported overground training.

Figure 4

Forest plot of ambulatory assessments. The SMDs and 95% CIs of comparison between the control intervention and other body weight-supported gait training therapies were as follows: RAGT = 0.30 (0.11, 0.50); BWSTT = 0.09 (− 0.40, 0.58); and BWSOGT = 0.09 (− 0.55, 0.73). RAGT, robot-assisted gait training; BWSTT, body weight-supported treadmill training; BWSOGT, body weight-supported overground training; SMD, standard mean difference; 95% CI, 95% credible interval.

Figure 5

Distribution of probabilities in the ranking of each body weight–supported gait training strategy. The ranking probabilities indicated that RAGT was the most effective, followed by BWSOGT, BWSTT, and the control intervention. RAGT, robot-assisted gait training; BWSTT, body weight-supported treadmill training; BWSOGT, body weight–supported overground training.

Figure 6

Forest plots of pairwise meta-analyses and network meta-analyses of ambulatory assessments. RAGT, robot-assisted gait training; BWSTT, body weight-supported treadmill training; BWSOGT, body weight-supported overground training.