Challenge Level Contributes to the Efficacy of Treadmill Interventions After Stroke: A Systematic Review and Meta-Analysis
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MDPI AG
Abstract
Intervention parameters such as the challenge, amount, and dosage (challenge × amount) have the potential to alter the efficacy of rehabilitation interventions after stroke. This systematic review investigated the effect of intervention parameters of challenge, amount, and dosage on improvements in walking outcomes following treadmill training (TT) and comparison interventions in people with stroke. Randomized controlled trials were included if they: (i) investigated interventions of TT or bodyweight-supported TT (BWSTT); (ii) made comparisons with other physiotherapy interventions, other types of TT, or no intervention; (iii) studied people with stroke; (iv) reported sufficient data on challenge and amount parameters; and (v) measured walking speed or endurance. Completeness of reporting was evaluated using the TIDieR-Rehab checklist and risk of bias was assessed using the revised Cochrane risk-of-bias tool. The review included 26 studies; 15 studies compared TT or BWSTT with other physiotherapy interventions and 11 studies compared different types of TT. Meta-analyses provided evidence with low to moderate certainty that greater differences in challenge and dosage between treadmill and comparison physiotherapy interventions produced greater effects on walking endurance (p < 0.01). However, challenge and dosage did not influence walking speed outcomes. The analysis of intervention amount was limited by the lack of studies that manipulated the amount of intervention. Overall, the findings indicate that, after stroke, some of the efficacy of TT on walking endurance can be explained by the challenge level during training. This supports the implementation of TT at higher challenge levels in stroke rehabilitation practice.Description
Keywords
challenge, dosage, dose, intensity, intervention reporting, stroke, treadmill training, 32 Biomedical and Clinical Sciences, 5201 Applied and Developmental Psychology, 5202 Biological Psychology, 3209 Neurosciences, 52 Psychology, Brain Disorders, Clinical Research, Neurosciences, Clinical Trials and Supportive Activities, Stroke, Rehabilitation, Stroke, 1109 Neurosciences, 1701 Psychology, 1702 Cognitive Sciences, 3209 Neurosciences, 5201 Applied and developmental psychology, 5202 Biological psychology
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Brain Sciences, ISSN: 2076-3425 (Print); 2076-3425 (Online), MDPI AG, 13(12), 1729-. doi: 10.3390/brainsci13121729
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© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
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