Treadmill training may be an effective form of task-specific training for improving mobility in people with Parkinson's disease and multiple sclerosis: a systematic review and meta-analysis
BACKGROUND:Task-specific training is an effective form of rehabilitation for improving mobility in neurological conditions. However, it remains unclear if task-specific training is effective in people with progressive disease. OBJECTIVE:To establish the efficacy of task-specific training on the mobility of individuals with progressive neurological conditions. DATA SOURCES:Electronic databases MEDLINE, EMBASE, CINAHL and Cochrane Database of Systematic Reviews. STUDY ELIGIBILITY CRITERIA:Randomised controlled trials investigating the effect of task-specific training on mobility and falls rate in individuals with progressive neurological conditions. STUDY APPRAISAL/SYNTHESIS METHODS:Risk of bias of individual studies was assessed using the Physiotherapy Evidence Database (PEDro) Scale. Mean differences (MD) and 95% confidence intervals were calculated and combined in meta-analysis. RESULTS:Analysis of 16 trials found treadmill training improved comfortable walking velocity (m/second) in people with Parkinson's disease (MD 0.21m/second, 95%CI 0.15 to 0.27) and multiple sclerosis (MD 0.36m/second, 95%CI 0.20 to 0.52). Treadmill training improved stride length (m) (MD 0.12m, 95%CI 0.02 to 0.23) and step length (m) (MD 0.12m, 95%CI 0.01 to 0.23) in people with Parkinson's disease and walking endurance in people with multiple sclerosis (MD 26.53m, 95%CI 12.23 to 40.84). Treadmill training had no effect on cadence and did not improve walking endurance in Parkinson's disease. Over-ground walking did not improve mobility in Parkinson's disease or multiple sclerosis. LIMITATIONS:Study sample sizes were small and findings must be interpreted with caution. CONCLUSION:Treadmill training may be effective for improving mobility in people with Parkinson's disease and multiple sclerosis. The effectiveness of over-ground walking is uncertain. SYSTEMATIC REVIEW PROSPERO REGISTRATION NUMBER:CRD42016047334.