Conventional therapy (package of interventions including gait training) vs treadmill gait training (with or without body weight support) to improve walking in people with SCI and motor function in the lower limbs | SCI Physiotherapy Clinical Practice Guidelines

	Conventional therapy (package of interventions including gait training) vs treadmill gait training (with or without body weight support) to improve walking in people with SCI and motor function in the lower limbs
P	People with SCI and motor function in the lower limbs	Evidence recommendation No evidence recommendation Reason: No recommendation due to insufficient or inconclusive evidence.		Strong opinion statement FOR Conventional therapy (package of interventions that includes gait training) should be provided (in favour of treadmill gait training with or without body weight support) to improve walking in people with SCI.
I	Conventional therapy (package of interventions that includes gait training)
C	Treadmill gait training (with or without body weight support)	Consensus-based opinion statement Strong for (96%)
O	Walking ability	Consensus-based opinion statement Strong for (96%)
	SUMMARY	4 RCTS		Mean difference (95% CI): Walking speed in m/s 0.08 (-0.12 to 0.27) Favours conventional therapy (package of therapies including gait training)
	GRADE Very low certainty ⨁◯◯◯	Risk of bias Very serious	Inconsistency No serious	Imprecision Serious	Indirectness No serious	Publication bias Serious

CONVENTIONAL THERAPY V TREADMILL ON ABILITY TO WALK: GRADE Evidence to Decision
PROBLEM	No	Probably no	Probably yes	Yes		Don't know
DESIRABLE EFFECTS	Trivial	Small	Moderate	Large		Don't know
UNDESIRABLE EFFECTS	Large	Moderate	Small	Trivial		Don't know
CERTAINTY OF EVIDENCE	Very low	Low	Moderate	High		No included studies
HOW MUCH PEOPLE VALUE THE MAIN OUTCOME	Important uncertainty or variability	Possibly important uncertainty or variability	Probably no important uncertainty or variability	No important uncertainty or variability
BALANCE OF EFFECTS	Favours the Control	Probably favours the Control	Does not favour either the intervention (I) or the comparison (C)	Probably favours the I	Favours the I	Don't know
RESOURCES REQUIRED	Large costs	Moderate costs	Negligible costs and savings	Moderate savings	Large savings	Don't know
CERTAINTY OF EVIDENCE OF REQUIRED RESOURCES	Very low	Low	Moderate	High		No included studies
COST EFFECTIVENESS	Favours the comparison	Probably favours the comparison	Does not favour either the intervention or the comparison	Probably favours the intervention	Favours the intervention	No included studies
EQUITY	Reduced	Probably reduced	Probably no impact	Probably increased	Increased	Don't know
ACCEPTABILITY	No	Probably no	Probably yes	Yes		Don't know
FEASIBILITY	No	Probably no	Probably yes	Yes		Don't know

CONVENTIONAL THERAPY V TREADMILL ON ABILITY TO WALK: Randomised Controlled Trial Details
STUDY	COMPARISON	DOSAGE/DETAILS	PARTICIPANTS	N (Rx/C)	OUTCOME	ROB 2 PEDRo
ALEXEEVA 2011	Conventional therapy V Body weight support treadmill training (BWSTT)	BWSTT: 30% BWS 60 mins of training, 3 x per week for 13 weeks	AIS C and D SCI	9/12	Walking speed m/s	Some Concerns of Risk of Bias PEDro = 7/10
LUCARELI 2011	Conventional therapy V BWSTT	BWSTT: 30 mins of training, 2 x per week for 4 months (total 30 sessions)	AIS C and D SCI	12/12	Walking speed m/s	Some Concerns of Risk of Bias PEDro = 6/10
PIIRA 2019	Conventional therapy V BWSTT	BWSTT: 2 daily sessions, 90 minutes per day, 5 days per week over 12 weeks	AIS C and D SCI	7/7	Walking speed m/s	Some Concerns of Risk of Bias PEDro = 7/10
SADEGHI 2015	Conventional therapy V BWSTT	BWSTT: 60 min per session, 4 x per week for 12 weeks	AIS B and C SCI	10/7	Walking speed m/s	High Risk of Bias PEDro = 6/10

The Australian and NZ SCI Physiotherapy guideline committee recommends conventional therapy (package of interventions that includes gait training) in favour of treadmill gait training with or without body weight support to improve walking

This is a consensus-based opinion statement supported by the opinions of the experts even though there is randomised controlled trials related to this topic. However, the result of these randomised controlled trials are either contradictory or inconclusive preventing an evidence recommendation. The guideline states:

Conventional therapy (package of interventions that includes gait training) should be provided (in favour of treadmill gait training with or without body weight support) to improve walking in people with SCI.

This statement was formed by considering the opinions of the experts alongside other factors. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility. The results of randomised controlled trials were also taken into consideration. This is a consensus-based opinion statement. Consensus-based opinion statements are less robust than evidence-based recommendations. They can be strong or weak.

This is a strong consensus-based opinion statement which means that the guideline panel is confident they can recommend conventional therapy (package of interventions that includes gait training) should be provided (in favour of treadmill gait training with or without body weight support) to improve walking based on opinion. To learn more about the research related to this intervention go to the clinicians tab on this website

Alexeeva N et al. Comparison of training methods to improve walking in persons with chronic spinal cord injury: a randomized clinical trial. Journal of spinal cord medicine 2011; 34: 362-369.
Lucareli PR, Lima MO, Lima FPS, et al. Gait analysis following treadmill training with body weight support versus conventional physical therapy: a prospective randomized controlled single blind study. Spinal Cord 2011 Sep;49(9):1001-1007.
Piira A, Lannem AM, Sorensen M, et al. Manually assisted body-weight supported locomotor training does not re-establish walking in non-walking subjects with chronic incomplete spinal cord injury: A randomized clinical trial. Journal of rehabilitation medicine 2019; 51: 113-119.
Sadeghi H, Banitalebi E, Dehkordi M. The effect of body-weight-supported training exercises on functional ambulation profile in patients with paraplegic spinal cord injury. Phys Treat 2015; 4: 205–212.