Treadmill gait training (with or without body weight support) vs Robotic gait training to improve walking in people with SCI and motor function in the lower limbs | SCI Physiotherapy Clinical Practice Guidelines

	Treadmill gait training (with or without body weight support) vs Robotic gait training 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.		Weak opinion statement FOR Treadmill gait training with or without body weight support may be provided (in favour of robotic gait training) to improve walking in people with SCI.
I	Treadmill gait training (with and without body weight support)
C	Robotic gait training	Consensus-based opinion statement Weak for (89%)
O	Ability to walk	Consensus-based opinion statement Weak for (89%)
	SUMMARY	2 RCTs (see references)		Standardised Mean Difference (95% CI) -0.2 (-0.8 to 0.4) Favours treadmill gait training (with or without body weight support)
	GRADE Very low certainty ⨁◯◯◯	Risk of bias Serious	Inconsistency Serious	Imprecision Very serious	Indirectness Serious	Publication bias Very serious

TREADMILL GAIT TRAINING V ROBOTIC GAIT TRAINING ON WALKING: 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 treadmill gait training	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 for both	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 for treadmill gait training		Don't know
FEASIBILITY	No	Probably no	Probably yes	Yes for treadmill gait training		Don't know

TREADMILL GAIT TRAINING V ROBOTIC GAIT TRAINING ON WALKING: Randomised Controlled Trial Details
STUDY	COMPARISON	DOSAGE/DETAILS	PARTICIPANTS	N (Rx/C)	OUTCOME	ROB 2 PEDRo
FIELD-FOTE 2011	Treadmill gait training V Robotic gait training	Intervention: BWSTT with manual assistance 5 days per week for 12 weeks Comparison: Robotic gait training 5 days per week for 12 weeks	Chronic SCI	14/17	Speed m/s	High Risk of Bias PEDro = 6/10
HORNBY 2005	Treadmill gait training V Robotic gait training	Intervention: BWSTT 3 x 30mins per week for 8 weeks Comparison: Robotic BWSTT 3 x 30mins per week for 8 weeks	T10 to L4 AIS B,C,D SCI	10/10	Walking index for SCI	Some Concerns of Risk of Bias PEDro = 3/10

The Australian and NZ SCI Physiotherapy guideline committee recommends treadmill gait training with or without body weight support in favour of robotic gait training to improve walking in people with SCI.

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

Treadmill gait training with or without body weight support may be provided (in favour of robotic gait training) 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 one randomised controlled trial was 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 probably recommend treadmill gait training with or without body weight support in favour of robotic gait training to improve walking in people with SCI based on opinion.

To learn more about the research related to this intervention go to the research summary.

Hornby TG, Campbell DD, Zemon DH, et al. Clinical and quantitative evaluation of robotic-assisted treadmill walking to retrain ambulation after spinal cord injury. Topics in Spinal Cord Injury Rehabilitation 2005 Fall;11(2):1-17.
Field-Fote Ec RKE. Influence of a locomotor training approach on walking speed and distance in people with chronic spinal cord injury: a randomized clinical trial. Physical therapy 2011; 91: 48.