QUESTION: Does mechanically assisted walking increase walking speed or distance in ambulatory people with stroke compared with no intervention/non-walking intervention, or with overground walking? DESIGN: Systematic review with meta-analysis of randomised trials. PARTICIPANTS: Ambulatory adults with stroke. INTERVENTION: Mechanically assisted walking (treadmill or gait trainer) without body weight support. OUTCOME MEASURES: Walking speed measured in m/s during the 10-m Walk Test and walking distance measured in m during the 6-min Walk Test. RESULTS: Nine studies of treadmill training comprising 977 participants were included. Treadmill training resulted in faster walking than no intervention/non-walking intervention immediately after the intervention period (MD 0.14m/s, 95% CI 0.09 to 0.19) and this was maintained beyond the intervention period (MD -0.12m/s, 95% CI 0.08 to 0.17). It also resulted in greater walking distance immediately after the intervention period (MD 40m, 95% CI 27 to 53) and this was also maintained beyond the intervention period (MD 40m, 95% CI 24 to 55). There was no immediate, statistically significant difference between treadmill training and overground training in terms of walking speed (MD 0.05m/s, 95% CI 0.12 to 0.21) or distance (MD -6 m, 95% CI -45 to 33). CONCLUSION: This systematic review provides evidence that, for people with stroke who can walk, treadmill training without body weight support results in faster walking speed and greater distance than no intervention or non-walking intervention and the benefit is maintained beyond the training period.

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