Mechanically assisted walking with body weight support results in more independent walking and better walking ability compared with usual walking training in non-ambulatory adults early after stroke: a systematic review

Abstract

Questions: In subacute, non-ambulatory individuals after stroke, does mechanically assisted walking with body weight support result in more independent walking or better walking ability than usual walking training in the short term? Are any benefits maintained in the longer term? Is it detrimental to walking in terms of walking speed?

Design: A systematic review with meta-analysis of randomised studies with a Physiotherapy Evidence Database (PEDro) score > 4.

Participants: Non-ambulatory adults ≤ 12 weeks after stroke.

Intervention: Any type of mechanically assisted walking with body weight support.

Outcome measures: Independent walking (ie, proportion of independent walkers), walking ability (eg, 0 to 5 Functional Ambulation Category, FAC) and walking speed.

Results: Fifteen studies involving 1,014 participants (mean PEDro score 6.4) were included. In the short term, mechanically assisted walking with body weight support resulted in more independent walking (RD 0.19, 95% CI 0.11 to 0.26) and better walking ability (MD 0.8 on the FAC, 95% CI 0.5 to 1.0) compared with the same amount of usual walking training. In the longer term, it resulted in better walking ability (MD 0.6 on the FAC, 95% CI 0.2 to 1.1). Mechanically assisted walking with body weight support does not appear to be detrimental to walking speed in the short term (MD 0.13 m/s, 95% CI 0.03 to 0.22) or longer term (MD 0.11 m/s, 95% CI 0.00 to 0.22).

Conclusion: This review provides high-certainty evidence that mechanically assisted walking with body weight support results in more independent walking and better walking ability in individuals with stroke who are non-ambulatory subacutely compared with usual walking training. Given the importance of achieving walking in the short term, clinicians are encouraged to use this intervention.

Registration: PROSPERO CRD42024549678.

Keywords: Body weight support; Mechanical assisted walking; Meta-analysis; Non-ambulatory; Stroke.