Efficacy of Walking Adaptability Training on Walking Capacity in Ambulatory People With Motor Incomplete Spinal Cord Injury: A Multicenter Pragmatic Randomized Controlled Trial.

Only 35 participants were analysed, and the planned sample size was based on earlier studies that were not directly comparable, so a small real difference could have been missed. The participants, therapists, investigators, and testers knew which training was given, which could bias outcomes. The analysis used only people who completed the follow-up assessments, not everyone who was assigned to a group. The study only included people who could walk at least 10 metres and at a comfortable speed between 0.3 and 1.0 m/s, so the results are limited to people within that walking range. Participants had to cancel other interventions aimed at walking capacity during the study period, so the comparison was made without concurrent walking treatments. The walking adaptability group took somewhat more steps per session than the conventional group, so the two groups were not perfectly matched for steps. Some participants may have been able to do more than the planned 20 minutes of active walking, so the dose may have been too low for them. Part of the study happened during the pandemic, which may have affected participation frequency scores. Some participants started near the top of the functional ambulation and participation restriction scales, so those tests may have had less room to show improvement. The main outcome was walking speed, which may not fully capture walking adaptability, and the study did not measure how well participants performed the adaptability tasks during training.

The authors declared no potential conflicts of interest. Funding was from the Dutch Research Council (NWO; Wearable Robotics: Exo-Aid for augmenting human physical capacities).