Rehabilitating Walking Ability After Stroke
In recent years, the authors published numerous meta-analyses and thus made an excellent contribution to an improved understanding of the differential therapeutic uses of intelligent mechanical training systems (robots) in the rehabilitation of walking ability and arms. For this reason, the research question and processing of of their recently published study, entitled “The improvement of walking ability following stroke,” seems strange.
In a systematic review of 95 randomized controlled trials including adult stroke patients unselected for severity of disability, the authors compare different interventions. The endpoints were gait velocity, distance walked and maximum walking distance. The result is sobering in that most of the reported interventions did not yield any significant improvements. Only exercising/training using end effector systems led to weakly significant improvements in gait velocity.
This meta-analysis has been conducted absolutely soundly. The problem, however, lies in the type of research question and the range of included patients. The crucial parameter in the rehabilitation of severely affected patients with hemiparesis after stroke is to restore the ability to walk autonomously, with or without assistive equipment. Improving walking speed is a secondary aspect that gains relevance only later, in patients whose ability to walk has been largely restored.
I can follow the authors’ argument (1) that highly repetitive walking therapy (for patients who are already able to walk) probably effectively improves their gait velocity. But unfortunately this study cannot contribute anything to the above mentioned key problem of how to rehabilitate walking ability after stroke. On this background, the title of the article (1) is misleading and should, in view of the convincing evidence to date, not be misunderstood in the sense of therapeutic nihilism for the problem of regaining the ability to walk after a stroke.
Prof. Dr. med. Dr. h. c. Volker Hömberg
Fachklinik für Prävention und Rehabilitation
SRH Gesundheitszentrum Bad Wimpfen GmbH
|1.||Mehrholz J, Pohl M, Kugler J, Elsner B: The improvement of walking ability following stroke—a systematic review and network meta-analysis of randomized controlled trials. Dtsch Arztebl Int 2018; 115: 639–45 VOLLTEXT|