A systematic review of mechanisms of gait speed change post-stroke. Part 2: exercise capacity, muscle activation, kinetics, and kinematics.
Elizabeth C Wonsetler, Mark G Bowden
PMID 28218021WHAT IT FOUND
No single laboratory measure consistently explained why stroke survivors walked faster after physical therapy.
Across 25 studies, changes in oxygen use, muscle activity, force, or joint motion were inconsistent, so gait speed gains may come from multiple pathways.
Key findings
01The review included 25 studies that all showed significant self-selected walking speed gains.
02No single mechanistic variable or group of variables explained those walking speed changes.
03Many included studies had high risk of bias, small samples, and varied intervention type, duration, and intensity.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
Many included studies had a high risk of bias, often because of design, lack of control group, and limited randomization. The studies varied widely in intervention type, duration, and intensity, and in which mechanistic outcome was measured. Several included studies had small sample sizes. The review included only studies where walking speed already improved, so it does not address mechanisms in people who did not improve walking speed. Mechanistic measures were costly, time-consuming, and mostly laboratory-based. They are hard to use in routine clinic.
The easy way to misread this
Do not read this review as proof that a specific physical therapy intervention improves walking speed through a proven mechanism. It describes studies that already had significant walking speed gains and found no consistent mechanistic explanation.