Moderate to Vigorous Intensity Locomotor Training After Stroke: A Systematic Review and Meta-analysis of Mean Effects and Response Variability.

The review was not pre-registered. Most participants could already walk without continuous assistance, so the results may not apply to patients who are non-ambulatory in the first weeks after stroke. Only four studies reported daily step counts, so the finding of no difference is imprecise and the range of possible effects was very wide. Adverse event reporting was inconsistent across studies, and all comparisons had high risk of bias for how events were measured: the same staff who delivered treatment also assessed events, without blinding. The meta-regression findings (for example, overground versus treadmill) are observational and may reflect confounding rather than a true effect of the training mode. The response variability measure does not separate differences between patients from variation within the same patient across sessions, so the probability estimates carry that ambiguity. Moderate between-study heterogeneity remained after accounting for stroke chronicity for comfortable and fastest gait speed (I-squared 60-61%).

Supported by NIH extramural funding, as listed in the publication metadata. No additional conflicts of interest statement was present in the provided text.

Do not assume that improved gait speed will carry over to more daily walking. The pooled difference in steps per day was not statistically significant, and the range of possible effects was wide enough to include both meaningful benefit and meaningful harm. A patient who walks faster in the clinic may still take the same number of steps at home.