Inclined treadmill training (ITT) for people with chronic stroke-a systematic review and meta-analysis

BackgroundConsidering the alterations in gait patterns and increase in metabolic demands during walking on an inclined surface, inclined treadmill training (ITT) may be an alternative treatment to non-inclined treadmill training (NITT) for improving gait and balance among people with chronic stroke.DesignWe searched eight electronic databases (August 2021), assessed risk of bias (Cochrane RoB 2.0 tool), and meta-analysed data (RevMan 3.5). Results were reported according to the PRISMA guidelines. Outcomes were gait parameters such as walking speed and balance-related outcome measures such as Berg Balance Scale scores. Risk of bias assessment was performed according to Version 2 of the Cochrane risk-of-bias tool for randomised trials (RoB 2).ResultsOf the screened citations, four met our inclusion criteria. Quantitative analysis showed ITT was significant in improving walking speed, stride length, paretic step length, Berg Balance Scale scores and Overall Stability Index (p < 0.05) but not in cadence, non-paretic step length, stance time on the non-paretic and paretic leg (p > 0.05). Only one study was rated low risk of bias.ConclusionThere was limited evidence for the superiority of ITT over NITT, in adjunct to other conventional intervention, for improving gait and balance among chronic stroke patients.