Influence of body weight unloading on human gait characteristics: a systematic review.

This review pooled gait measurements taken during walking under body weight support, not after training, so it cannot show whether patients improve clinically. Many included studies were small: participants per study ranged from 1 to 28, with an average of 12, and only 27% of studies were in people with neurological impairment. For the statistical analysis, neurologically impaired participants were combined across spinal cord injury, stroke and Parkinson's disease because there were too few studies for each group. In the pooled analysis, muscle activity data came only from people with Parkinson's disease, other gait parameter data came only from people with stroke, and spinal cord injury data was not included. Only 53% of publications explicitly stated randomization, and the authors say the low number of participants and lack of randomized trials can lead to suboptimal study design. Studies varied in walking speed, body weight support system, amount of unloading, and which gait measures were reported, so comparisons required normalization and interpolation. Overground impaired group data for some gait phases and joint range came from a single study. Modulated unloading was rarely studied, with about 13% of studies and an average of 6 participants. There is no single way to compare gait, and 26 parameters were analyzed even though some had very few studies.

The paper states that Horizon 2020 Framework Programme funded the work.

Do not read the reduced forces and muscle activity as proof that body-weight supported training makes patients walk better. The review measured gait while unloading was applied, not clinical outcomes after treatment.