Methods

Parallel group design.
Concealed randomisation of participants by ranking the participants according to independent walking speed at baseline (from fastest to slowest) and then allocating each descending pair of participants by coin toss.
14% dropouts at end of treatment and 10% dropouts at the end of follow‐up phase.
Outcome assessors were blinded to group allocation.

Participants

14 participants in the EXP group, and 15 participants in the CTL group.
Inclusion criteria:
(1) less than 5 years post‐stroke;
(2) first stroke;
(3) clinically diagnosed hemiparesis;
(4) aged 50 to 85 years;
(5) can walk 10 m independently with a speed less than 1 m/sec;
(6) discharged from rehabilitation.
Exclusion criteria:
(1) cardiovascular disease that would preclude participation in training (assessed by the participant's medical practitioner);
(2) severe cognitive deficits that would preclude participation in training.

Interventions

Treated as outpatients for 3 30‐minute sessions per week for 4 weeks.
Treadmill training (EXP): participants walk on a treadmill (no body weight support was provided using a harness) and complete some overground walking training (the proportion of overground training is gradually increased).
Sham training (CTL): home‐based exercises based on written instructions with weekly telephone contact to review and update the exercises.

Outcomes

Assessed at baseline, after treatment phase and 3 month follow up:
(1) independent preferred walking speed over 10m (barefoot and without gait aids);
(2) step length and width;
(3) cadence;
(4) walking endurance ‐ maximum distance covered in 6 minutes using preferred gait aid;
(5) 30‐item Stroke Adjusted Sickness Impact Profile.

Notes

Obtained unpublished data by interview and correspondence with the trialists.

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate

Methods

Parallel group design.
Participants randomised to groups using a random number table.
Allocation to groups was not concealed.
13% dropouts at end of treatment phase.
Outcome assessors were not blinded to group allocation.

Participants

7 participants in the EXP group, and 8 participants in the CTL group.
Inclusion criteria:
(1) less than 6 weeks post‐stroke;
(2) hemiparetic stroke based on clinical examination or MRI, or both;
(3) significant gait deficit ‐ speed of no more than 36 m/min or FAC 0 to 2 (that is, needs assistance);
(4) sufficient cognition to participate in training (at least 21 on the Mini Mental State Examiniation);
(5) ability to stand and take at least 1 step with or without assistance;
(6) informed consent.
Exclusion criteria:
(1) any co‐morbidity or disability other than hemiparesis that would preclude gait training;
(2) recent myocardial infarction;
(3) any uncontrolled health condition for which exercise is contraindicated (eg, diabetes);
(4) severe lower extremity joint disease or rheumatoid arthritis that would interfere with gait training;
(5) obesity (mass more than 110 kg).

Interventions

Treated as inpatients for 5 20‐minute sessions per week for 2‐3 weeks.
Treadmill training with body weight support (EXP): participants walked on a treadmill with up to 30% of their body weight supported using a harness.
Regular gait training (CTL): strengthening, functional and mobility activities.

Outcomes

Assessed at baseline and after treatment phase:
(1) FAC;
(2) FIM ‐ locomotion score;
(3) fast walking speed over 5 m using a gait aid and personal assistance, if required;
(4) walking endurance ‐ maximum distance walked in 5 minutes, using parallel bars if necessary;
(5) energy expenditure during gait;
(6) bike ergometer exercise test.

Notes

The rating of dropouts and the allocation concealment classification were changed based on correspondence from the trialist.

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

High risk

C ‐ Inadequate

Methods

Parallel group design.
Concealed randomisation of participants to groups by having a person independent to the study draw a card from a box (there were 6 EXP and 6 CTL cards and they were not replaced after each draw).
25% dropouts at end of treatment phase, 33% dropouts at 2 month follow up.
Blinding of outcome assessors to group allocation for all clinical measurements except walking endurance ‐ however, assessor may have been unmasked by inadvertently viewing 1 training session.

Participants

6 participants in the EXP group, and 6 participants in the CTL group.
Inclusion criteria:
(1) first stroke resulting in hemiplegia;
(2) at least 3 months post‐stroke;
(3) discharged from all rehabilitation services;
(4) able to attend rehabilitation centre 3 times per week for 4 weeks;
(5) able to walk 10 m independently (with or without a gait aid);
(6) able to provide own transport;
(7) informed consent.
Exclusion criteria:
(1) any medical condition that would prevent participation in a training program.

Interventions

Treated as outpatients for 3 1‐hour sessions per week for 4 weeks.
Task‐oriented lower limb training circuit class (EXP): particpants rotated around 10 5‐minute stations designed to strengthen the muscles of the affected leg and practice locomotor tasks (one station was walking on a treadmill, no body weight support was provided using a harness) plus 10 minutes of walking races and relays.
Task‐oriented upper limb training circuit class (CTL): participants rotated around stations and completed group activities designed to improve control of the muscles of the affected arm and reaching and grasping.

Outcomes

Assessed at baseline, after treatment phase and 2 months later:
(1) independent preferred walking speed over 10 m with and without a gait aid but without supervision;
(2) walking endurance ‐ maximum distance walked in 6 minutes using preferred gait aid (supervision, but not personal assistance was provided);
(3) step test;
(4) timed up and go.

Notes

The CTL group received sham treatment (ie, upper limb training) ‐ at the end of training all but 1 subject indicated that they would recommend the program to others.

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate

Methods

Parallel group design.
Concealed randomisation of participants to groups by having a person independent to the study asking the participant to draw a sealed opaque envelope from a box (each envelope contained the group allocation and there were 25 EXP and 25 CTL envelopes). 0% dropouts at end of treatment and 2% dropouts at the end of follow‐up phase.
Outcome assessors were blinded to group allocation.

Participants

25 participants in the EXP group, and 25 participants in the CTL group.
Inclusion criteria:
(1) first time supratentorial stroke;
(2) less than 6 weeks post‐stroke;
(3) aged 50‐75 years;
(4) scores 50‐80 on 100‐point Barthel Index;
(5) able to walk a minimum distance of 12 m with either intermittent help or stand‐by assistance;
(6) cardiovascular stable;
(7) participation in a 12‐week comprehensive rehabilitation program;
(8) no other neurologic or orthopaedic disease imparing walking;
(9) able to understand the purpose and content of the study;
(10) written consent.

Interventions

Treated as inpatients for 5 30‐minute sessions per week for 6 weeks.
Treadmill training with body weight support (EXP): participants walked on a treadmill with up to 15% of their body weight supported using a harness. The slope and speed of the treadmill were adjusted to achieve a training heart rate.
Regular gait training (CTL): tone‐inhibiting and gait preparatory manouvres and walking practice on the floor and stairs based on Bobath (non‐task‐oriented ‐ 'neurophysiological').

Outcomes

Assessed at baseline, after treatment phase, and 3 months later:
(1) fast walking speed over 10 m with or without a gait aid (supervision and personal assistance was provided, if required);
(2) walking endurance ‐ maximum distance walked in 6 minutes without rest stops, the test was terminated if the participant needed to stop and rest, with or without a gait aid (use of supervision and personal assistance not reported);
(3) walking ability using the Rivermead Motor Assessment scale (13 point scale);
(4) walking quality using an adapted checklist from Los Ranchos Los Amigos Gait Analysis Handbook (41‐point scale).

Notes

Method of randomisation and the allocation concealment classification were changed based on correspondence from the trialist.

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate

Methods

Parallel group design.
Concealed randomisation of participants to groups by using an Excel spreadsheet with group allocation masked using black cells.
15% dropouts at end of treatment phase, and 15% dropouts at end of 2‐week follow up.
Blinding of outcome assessors to group allocation.

Participants

11 participants in the EXP group, and 12 participants in the CTL group.
Inclusion criteria:
(1) at least 6 months post‐stroke;
(2) hemiplegia secondary to documented lesion;
(3) able to walk independently or with stand‐by supervision (with or without a gait aid);
(4) asymmetric gait pattern and short step length;
(5) 'average' or 'minimal impairment' in all Cognistat test categories;
(6) informed consent.
Exclusion criteria:
(1) any medical condition that would prevent participation in a training program;
(2) inability to follow instructions.

Interventions

Treated as outpatients for 6 1‐hour sessions per week for 2 weeks.
Virtual reality and treadmill training (EXP): participants practiced stepping over virtual objects while walking on a treadmill, with a harness to prevent falls (each session consisted of 12 trials of stepping over 10 obstacles).
Overground training (CTL): participants practiced stepping over real objects while walking overground, with a gait belt for safety (each session consisted of 12 trials of stepping over 10 obstacles; task‐oriented).

Outcomes

Assessed at baseline, after treatment phase and 2 weeks later:
(1) independent preferred walking speed over 6 m with or without a gait aid (supervision, but not personal assistance, was provided);
(2) independent fast walking speed over 6 m with or without a gait aid (supervision, but not personal assistance, was provided);
(3) walking endurance ‐ maximum distance walked in 6 minutes with or without a gait aid (supervision, but not personal assistance, was provided);
(4) spatial and temporal gait variables;
(5) ability to clear obstacles.

Notes

Rating of concealed allocation, assessor blinding and dropouts, and the allocation concealment classification were changed based on correspondence from the trialist.

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Unclear risk

B ‐ Unclear

Methods

Parallel group design.
Participants randomised to groups using a random number table.
Concealed allocation to groups by a person independent to the study.
5% dropouts at end of treatment phase.
Blinding of outcome assessors to group allocation.

Participants

22 participants in the EXP group, and 34 participants in the CTL group.
Inclusion criteria:
(1) no prior stroke;
(2) independent with ambulation prior to stroke;
(3) no active angina pectoris or orthostatic hypertension;
(4) free of other neurologic or orthopaedic disorders that might preclude walking;
(5) FIM walking subscore less than or equal to 3 (indicating at least moderate assistance is required for ambulation);
(6) hemiparesis with iliopsoas strength less than or equal to 3 out of 5 (indicating significant weakness ‐ full range of movement against gravity only);
(7) written informed consent.

Interventions

Treated as inpatients for 5 45‐minute sessions per week for an average of 12.5 (SD 4.7) total treatment sessions.
Treadmill training with body weight support (EXP): participants walked on a treadmill and were provided with manual guidance for weight shifting, leg advancement and foot placement.
Aggressive bracing assisted walking (CTL): participants walked with the assistance of knee‐ankle combination bracing and a hemi‐bar (non‐task‐oriented ‐ 'orthopaedic').

Outcomes

Assessed at baseline and after treatment phase:
(1) preferred walking speed over a 2 minute test period (participants allowed to use gait aids and personal assistance, if required);
(2) walking endurance ‐ the distance walked at a preferred speed until the participant indicated fatigue or they exhibited fatigue‐related deterioration in gait (participants allowed to use gait aids and personal assistance, if required).

Notes

Rating of concealed allocation and the allocation concealment classification were changed based on correspondence from the trialist.

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate

Methods

Parallel group design.
Alternate assignment of participants to groups, therefore allocation to groups not concealed.
14% dropouts at end of treatment phase.
Blinding of outcome assessors to group allocation.

Participants

15 participants in the EXP group, and 14 participants in the CTL group.
Inclusion criteria:
(1) first supratentorial stroke in anterior brain circulation as evidenced by CT scanning;
(2) no additional neurological or orthopaedic deficiencies impairing ambulation;
(3) no cardiac, respiratory or medical condition that could interfere with the protocol;
(4) no severe cognitive or communication impairment;
(5) onset of stroke no more than 90 days prior to recruitment;
(6) ability to walk on treadmill at a speed of at least 0.2 km/hr for 2 minutes without rest with minimal to moderate assistance;
(7) have begun ambulation training.

Interventions

Treated as inpatients for 5 sessions of up to 20 minutes per week for 3 weeks (15 treatment sessions).
Treadmill training (EXP): participants walked on a treadmill at a comfortable speed with a therapist assisting leg movements, they were permitted use a handrail for external support if required. No body weight support using a harness was provided.
Overground walking (CTL): participants walked on a floor surface using gait aids, assistance and rest periods as needed.

Outcomes

Assessed at baseline and after treatment phase:
(1) independent fast walking speed over 10 m (participants allowed to use gait aids and supervision, if required);
(2) FAC;
(3) standing balance test;
(4) gait aids used;
(5) temporal characteristics of gait;
(6) stride length;
(7) calf muscle EMG activity.

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

High risk

C ‐ Inadequate

Methods

Cross‐over group design.
Participants randomised to groups by the toss of a coin.
Allocation concealment not reported.
17% dropouts at end of first treatment phase.
Blinding of outcome assessors to group allocation.

Participants

10 participants allocated to the EXP then CTL order, and 8 participants allocated to the CTL then EXP order.
Inclusion criteria:
(1) higher level gait disorder;
(2) CT scan with large vessel infarct, basal ganglia and white matter lacunes, or extensive leukoaraiosis;
(3) discharged from all rehabilitation services;
(4) informed consent.
Exclusion criteria:
(1) severe cognitive impairment;
(2) significant physical impairments from other causes.

Interventions

Treated as inpatients or outpatients for 3 1‐hour sessions per week for 4 weeks.
Treadmill training (EXP): participants walked on a treadmill for as long as they felt comfortable, rest breaks were allowed. No body weight support was provided using a harness.
Conventional physiotherapy (CTL): a schedule of 31 interventions in 3 treatment modules: gait ignition or failure, postural alignment, and other.

Outcomes

Assessed at baseline, at cross‐over (4 weeks), after treatment phase (at 8 weeks) and 6 weeks after final treatment:
(1) independent preferred walking speed over 10m using a gait aid and supervision, if required;
(2) walking step length;
(3) walking cadence;
(4) sit‐to‐stand test;
(5) 1‐leg stand;
(6) s‐test for walking;
(7) ADL‐oriented assessment of mobility;
(8) Nottingham Extended ADL Scale.

Notes

The rating of dropouts was changed based on correspondence from the trialist. Data treated as a parallel group design for this review by using the first treatment phase only (that is baseline and cross‐over data only).

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Unclear risk

B ‐ Unclear

Methods

Parallel group design.
Participants randomised to groups using a computer generated randomisation scheme that was stratified by walking speed (less than 0.44 m/sec and more than or equal to 0.44 m/sec) and age (less than 65 years and more than or equal to 65 years).
Concealed allocation to groups not reported.
26% dropouts at end of treatment phase.
Blinding of outcome assessors to group allocation for gait and balance outcomes (i.e. outcomes 1, 2, 3 and 6).

Participants

32 participants in the EXP group, and 29 participants in the CTL group.
Inclusion criteria:
(1) chronic ischaemic stroke (less than 6 months);
(2) residual mild to moderate hemiplegic gait deficits;
(3) completion of all conventional physiotherapy;
(4) aged 45 years or more;
(5) independently ambulant with or without a gait aid or stand‐by help.
Exclusion criteria:
(1) heart failure, unstable angina, peripheral arterial occlusive disease;
(2) aphasia (inability to follow two‐point commands);
(3) dementia;
(4) untreated major depression;
(5) other medical conditions precluding aerobic exercise.

Interventions

Treated as outpatients for 3 40‐minute sessions per week for 6 months.
Treadmill training (EXP): participants walked on a treadmill to achieve a target aerobic intensity of 60% to 70% heart rate reserve (progressive aerobic training). No body weight support was provided using a harness.
Conventional physiotherapy (CTL): participants completed a supervised stretching and low intensity walking program (5 minutes walking on a treadmill at 30% to 40% heart rate reserve without body weight support; task oriented).

Outcomes

Assessed at baseline and after treatment phase:
(1) independent self selected walking speed over 30 feet (participants allowed to use gait aids and supervision, if required);
(2) independent fastest comfortable walking speed over 30 feet (participants allowed to use gait aids and supervision, if required);
(3) walking endurance ‐ maximum distance covered in 6 minutes using preferred gait aid;
(4) peak exercise capacity;
(5) rate of oxygen consumption during submaximal effort treadmill walking (economy of gait);
(6) balance using an instrumented balance assessment system.

Notes

Method of randomisation and rating of assessor blinding were changed based on correspondence from the trialist.
Obtained unpublished data by correspondence with the trialists.

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Unclear risk

D ‐ Not used

Methods

Parallel group design.
Participants randomised to groups using a random number computer program.
Concealed allocation to groups using sealed, opaque and consecutively numbered envelopes.
10% dropouts at end of treatment phase, 18% dropouts at 10 month follow up.
Blinding of outcome assessors to group allocation.

Participants

36 participants in the EXP group, and 37 participants in the CTL group.
Inclusion criteria:
(1) first stroke with residual hemiparesis;
(2) aged less than 70 years;
(3) onset of stroke no more than 8 weeks prior to recruitment;
(4) take longer than 14 seconds to walk 10 m;
(5) informed consent.
Exclusion criteria:
(1) patients with heart disease, psychiatric illness or incapable of cooperating;
(2) patients with other severe disabilities (eg, rheumatoid arthritis) that might hinder training;
(3) patients participating in other studies.

Interventions

Treated as inpatients for 5 30‐minute sessions per week for the duration of inpatient rehabilitation.
Treadmill training with body weight support (EXP): participants walked on a treadmill with up to 2 therapists assisting leg movements, they were permitted to use a handrail for external support if required.
Overground walking training (CTL): participants practiced walking on a floor surface based on a Motor Relearning Program guidelines.

Outcomes

Assessed at baseline, after treatment phase (when discharged from inpatient rehabilitation) and 10 months after stroke:
(1) preferred walking speed over 10 m (participants allowed to use gait aids and personal assistance if required);
(2) FAC;
(3) FIM;
(4) Fugl‐Meyer Stroke Assessment;
(5) Berg Balance Scale.

Notes

Allocation concealment classification was changed based on correspondence from the trialist. Data divided into two comparisons, see Nilsson 2001a and Nilsson 2001b.

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate

Methods

See Nilsson 2001

Participants

See Nilsson 2001

Interventions

See Nilsson 2001

Outcomes

See Nilsson 2001

Notes

For Nilsson 2001a, data from the 54 participants who were dependent walkers at the start of treatment were used (26 EXP and 28 CTL). These walking dependency data were obtained through correspondence with the authors.

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate

Methods

See Nilsson 2001

Participants

See Nilsson 2001

Interventions

See Nilsson 2001

Outcomes

See Nilsson 2001

Notes

For Nilsson 2001b, data from the 19 participants who were independent walkers at the start of treatment were used (10 EXP and 9 CTL). These walking dependency data were obtained through correspondence with the authors.

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate

Methods

Parallel group design.
Participants randomised to groups (block randomisation with participants stratified for walking speed).
Concealed allocation to groups using sealed, opaque envelopes.
13% dropouts at end of treatment phase.
Blinding of outcome assessors to group allocation.

Participants

22 participants in the EXP 1 group, 22 participants in the EXP 2 group and 25 participants in the CTL group.
Inclusion criteria:
(1) hemiparesis caused by ischaemic stroke;
(2) impaired gait (takes 5 to 60 seconds to walk 10 metres);
(3) hemiparesis more than 4 weeks;
(4) no or slight spasticity (0 or 1 on the Ashworth scale);
(5) able to walk without assistance (FAC of 3 or more);
(6) informed consent.
Exclusion criteria:
(1) previous treadmill training;
(2) class C or D exercise risk (American College of Sports Medicine Guidelines);
(3) cognitive deficits (less than 26 out of 30 on Mini Mental State Examination);
(4) movement disorders,
orthopaedic or other gait influencing disease.

Interventions

Treated as inpatients for 3 30‐ (EXP 1 and EXP 2) or 45‐ (CTL) minute sessions per week for 4 weeks.
Speed‐dependent treadmill training with body weight support (EXP 1): participants walked on a treadmill without therapist assistance, speed was progressed using an aggressive protocol.
Limited progressive treadmill training with body weight support (EXP 2): participants walked on a treadmill with therapists assisting the walking cycle, speed was progressed using conservative protocol.
Conventional gait therapy (CTL): traditional physiotherapy based on neurophysiological techniques.

Outcomes

Assessed at baseline and after treatment phase:
(1) independent preferred walking speed over 10 m using gait aids, if required;
(2) FAC;
(3) cadence;
(4) stride length.

Notes

The rating of concealed allocation and the allocation concealment classification were changed based on correspondence from the trialist. Data divided into two comparisons, see Pohl 2002a and Pohl 2002b.

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Unclear risk

B ‐ Unclear

Methods

See Pohl 2002.

Participants

See Pohl 2002.

Interventions

See Pohl 2002.

Outcomes

See Pohl 2002.

Notes

For Pohl 2002a, EXP 1 group was compared to CTL. Half of the CTL group data were used for this comparison.

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Unclear risk

B ‐ Unclear

Methods

See Pohl 2002.

Participants

See Pohl 2002.

Interventions

See Pohl 2002.

Outcomes

See Pohl 2002.

Notes

For Pohl 2002b, EXP 2 group was compared to CTL. Half of the CTL group data were used for this comparison.

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Unclear risk

B ‐ Unclear

Methods

Parallel group design.
Participants randomised to groups using a stratified block randomisation scheme.
Concealed allocation to groups not reported.
15% dropouts at end of treatment phase, number of dropouts not reported at 3 and 6 month follow ups.
Blinding of outcome assessors to group allocation.

Participants

10 participants in the EXP group, 8 participants in the CTL 1 group, and 9 participants in the CTL 2 group.
Inclusion criteria:
(1) resident within 50 km of Quebec;
(2) aged 40‐80 years;
(3) less than 7 days after onset of first stroke;
(4) clinically identifiable middle cerebral artery syndrome of thromboembolic origin involving sub‐cortical structures confirmed by CT;
(5) under medical supervision of study neurologists;
(6) informed consent;
(7) middle‐band disability according to Garraway (ie, excluded patients independent in ambulation as well as those who were unconscious).
Exclusion criteria:
(1) other neurological problems;
(2) major medical problems that would incapacitate functional capacity.

Interventions

Treated as inpatients for 6 weeks for a mean of 1.74 (SD 0.15) (EXP), 1.79 (SD 0.10) (CTL 1) and 0.72 (SD 0.10) (CTL 2) hours per day.
Early intensive task‐oriented physiotherapy (EXP): treatment started as early as possible after stroke and included treadmill training (no body weight support was provided using a harness), tilt table exercises and resisted exercises using isokinetic equipment.
Early intensive traditional physiotherapy (CTL 1): treatment started as early as possible after stroke and included traditional physiotherapy based on neurophysiological techniques.
Delayed non‐intensive traditional physiotherapy (CTL 2): treatment started later after stroke and included less intense traditional physiotherapy based on neurophysiological techniques.

Outcomes

Assessed at baseline, after treatment phase and 3 and 6 months later:
(1) walking speed over 4 m (personal assistance could be used, but speed of test (preferred or fast), supervision and gait aid use not reported);
(2) 15‐item Barthel Index;
(3) Fugl‐Meyer;
(4) Berg Balance Scale.

Notes

3 and 6 month follow‐up data not reported.
We chose to compare the EXP and CTL 1 groups only for this review because they had the same intensity and starting time of therapy.

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Unclear risk

B ‐ Unclear

Methods

Cross‐over group design.
Participants randomised to groups (method of randomisation and concealment not stated).
0% dropouts at end of first treatment phase.
Blinding of outcome assessors to group allocation not reported.

Participants

15 participants allocated to the EXP then CTL order, and 15 participants allocated to the CTL then EXP order.
Inclusion criteria:
(1) hemiparesis;
(2) stroke (infarct or haemorrhage);
(3) at least 4 weeks post stroke;
(4) not able to walk;
(5) able to stand for 20 seconds.
Exclusion criteria:
(1) cardiovascular problems or infections with a decrease in general health.

Interventions

Treated as inpatients for 5 1‐hour sessions per week for 3 weeks.
Treadmill training with body weight support (EXP): participants walked on a treadmill with partial body weight support provided by a harness for 30 minutes plus completed 30 minutes of usual physiotherapy per day.
Usual physiotherapy (CTL): participants completed 2, 30 minute sessions of usual physiotherapy per day.

Outcomes

Assessed at baseline, at cross‐over (3 weeks), and after treatment phase (at 6 weeks):
(1) RMAS;
(2) walking speed over 10 m (item 6 of the RMAS) (the speed of test (preferred or fast), personal assistance, supervision and gait aid use were not reported);
(3) a unique gait scale based on clinical assessment.

Notes

Data treated as a parallel group design for this review by using the first treatment phase only (that is baseline and cross‐over data only).

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Unclear risk

B ‐ Unclear

Methods

Parallel group design.
Participants randomised to groups using a stratified block randomisation scheme.
Allocation was concealed using sealed and numbered envelopes.
21% dropouts at end of treatment phase, 48% dropouts at 3 month follow up.
Blinding of outcome assessors to group allocation.

Participants

50 participants in the EXP group, and 50 participants in the CTL group.
Inclusion criteria:
(1) admitted to the Jewish Rehabilitation Hospital for physical rehabilitation after stroke;
(2) abnormal gait;
(3) no severe cardiac problems;
(4) no comorbid conditions contraindicating treadmill training;
(5) not cerebellar, bilateral or brain stem stroke;
(6) able to understand simple commands;
(7) anticipated length of stay of at least 4 weeks;
(8) onset of stroke no more than 6 months prior to recruitment;
(9) able to ambulate pre‐stroke;
(10) first admission during study period;
(11) treadmill training timeslot available;
(12) informed consent.

Interventions

Treated as inpatients for 4 20‐minute session per week for 6 weeks.
Treadmill training with body weight support (EXP): participants walked on a treadmill with partial body weight support using a harness and the assistance of 1 to 2 therapists.
Treadmill training only (CTL): participants walked on a treadmill with the assistance of 1 to 2 therapists. No body weight support was provided using a harness.

Outcomes

Assessed at baseline, after treatment phase and 3 months later:
(1) preferred walking speed over 3 m (personal assistance and gait aids could be used);
(2) walking endurance ‐ maximum distance walked up to a maximum of 320 m (personal assistance and gait aids could be used);
(3) Berg Balance Scale;
(4) Stroke Rehabilitation Assessment of Movement.

Notes

The rating of concealed allocation and the allocation concealment classification were changed based on correspondence from the trialist. Data divided into two comparisons, see Visintin 1998a and Visintin 1998b.

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate

Methods

See Visintin 1998.

Participants

See Visintin 1998.

Interventions

See Visintin 1998.

Outcomes

See Visintin 1998.

Notes

For Visintin 1998a, data from the 59 participants who were dependent walkers at the start of treatment and who did not dropout before the end of the treatment phase were used (33 EXP and 26 CTL). These walking dependency data were obtained through correspondence with the authors.

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate

Methods

See Visintin 1998.

Participants

See Visintin 1998.

Interventions

See Visintin 1998.

Outcomes

See Visintin 1998.

Notes

For Visintin 1998b, data from the 20 participants who were independent walkers at the start of treatment and who did not dropout before the end of the treatment phase were used (10 EXP and 10 CTL). These walking dependency data were obtained through correspondence with the authors.

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate

Methods

Cross‐over group design.
Participants randomised to groups (group allocation in envelopes that were drawn by an independent person).
0% dropouts at end of first treatment phase.
Blinding of outcome assessors to group allocation.

Participants

15 participants allocated to the EXP then CTL order, and 15 participants allocated to the CTL then EXP order.
Inclusion criteria:
(1) first stroke;
(2) supratentorial lesion;
(3) 4 to 12 weeks post stroke;
(4) aged less than 75 years;
(5) not able to walk (FAC of 2 or less);
(6) able to sit unsupported on the edge of a bed;
(7) able to stand for at least 10 seconds with help;
(8) written informed consent.
Exclusion criteria:
(1) hip and knee extension deficit of more than 20 degrees;
(2) passive dorsiflexion of the affected ankle to less than a neutral position;
(3) severe impairment of cognition or communication;
(4) evidence of cardiac ischaemia, arrhythmia, decompression or heart failure;
(5) feeling of 'overexertion' or heart rate exceeding the age‐predicted maximum (ie, 190 beats/min minus age) during training;
(6) resting systolic blood pressure exceeding 200 mmHg at rest or dropping by more than 10 mmHg with increasing workload.

Interventions

Treated as inpatients for 5 15‐20 minute sessions per week for 2 weeks.
Treadmill training with body weight support (EXP): participants walked on a treadmill with partial body weight support provided by a harness.
GaitTrainer with body weight support (CTL): participants walked on a GaitTrainer with partial body weight support provided by a harness.

Outcomes

This was an A‐B‐A (or B‐A‐B) design, so participants were assessed at baseline, at first cross‐over (2 weeks), at second cross‐over (4 weeks) and after treatment phase (6 weeks):
(1) FAC;
(2) fast walking speed over 10 m with personal assistance and gait aids, if required;
(3) RMAS;
(4) ankle spasticity (modified Ashworth Scale).

Notes

The number of dropouts was changed based on correspondence with the trialists. Data treated as a parallel group design for this review by using the first treatment phase only (that is baseline and first cross‐over data only).

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate