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Abstract：
OBJECTIVE: This meta-analysis quantified mean effects of moderate to vigorous intensity locomotor training (LT mv ) on walking outcomes in subacute and chronic stroke, and the magnitude of variability in LT mv response.
METHODS: Databases were searched for randomized trials comparing LT mv with no intervention, nongait intervention, or low-intensity gait training. Comfortable gait speed (CGS), fastest gait speed (FGS), 6-minute walk test (6MWT), walking activity (steps per day), and adverse effect/event (AE) data were extracted. Pooled estimates were calculated for mean changes, AE relative risks, and the standard deviation of response (SD response ) to LT mv versus control groups, stratified by study chronicity where possible.
RESULTS: There were 19 eligible studies (total N = 1096): 14 in chronic stroke (N = 839) and 5 in subacute stroke (N = 257). Compared with control interventions, LT mv yielded significantly greater increases in CGS (chronic, +0.06 m/s [95% confidence interval (CI), 0.01-0.10]; subacute, +0.16 [0.12-0.19]; subacute vs chronic, P = 0.03), FGS (chronic, +0.07 m/s [0.02-0.13]; subacute, +0.21 [0.01, 0.41]; P = 0.04), and 6MWT (chronic, +33 m [24-42]; subacute, +51 [26-77]; P = 0.054) but not steps/day (+260 [-1159 to 1679]). There were no treatment-related serious AEs among 398 LT mv participants in 14 AE-reporting studies. SD response estimates indicated substantial response variability: CGS, 0.11 m/s [0.00-0.15]; FGS, 0.14 m/s [-0.00 to 0.20]; and 6MWT, 41 m [27-51].
CONCLUSIONS: LT mv improves mean walking capacity outcomes in subacute and chronic stroke and does not appear to have high risk of serious harm. Response magnitude varies within and between chronicity subgroups, and few studies have tested effects on daily walking activity or non-serious AEs.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A452 ).
METHODS: Databases were searched for randomized trials comparing LT mv with no intervention, nongait intervention, or low-intensity gait training. Comfortable gait speed (CGS), fastest gait speed (FGS), 6-minute walk test (6MWT), walking activity (steps per day), and adverse effect/event (AE) data were extracted. Pooled estimates were calculated for mean changes, AE relative risks, and the standard deviation of response (SD response ) to LT mv versus control groups, stratified by study chronicity where possible.
RESULTS: There were 19 eligible studies (total N = 1096): 14 in chronic stroke (N = 839) and 5 in subacute stroke (N = 257). Compared with control interventions, LT mv yielded significantly greater increases in CGS (chronic, +0.06 m/s [95% confidence interval (CI), 0.01-0.10]; subacute, +0.16 [0.12-0.19]; subacute vs chronic, P = 0.03), FGS (chronic, +0.07 m/s [0.02-0.13]; subacute, +0.21 [0.01, 0.41]; P = 0.04), and 6MWT (chronic, +33 m [24-42]; subacute, +51 [26-77]; P = 0.054) but not steps/day (+260 [-1159 to 1679]). There were no treatment-related serious AEs among 398 LT mv participants in 14 AE-reporting studies. SD response estimates indicated substantial response variability: CGS, 0.11 m/s [0.00-0.15]; FGS, 0.14 m/s [-0.00 to 0.20]; and 6MWT, 41 m [27-51].
CONCLUSIONS: LT mv improves mean walking capacity outcomes in subacute and chronic stroke and does not appear to have high risk of serious harm. Response magnitude varies within and between chronicity subgroups, and few studies have tested effects on daily walking activity or non-serious AEs.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A452 ).
摘要：
目的：这项荟萃分析量化了中等至高强度运动训练（LTmv）对亚急性和慢性卒中步行结局的平均影响，以及LTmv响应变化的幅度。
方法：在数据库中搜索比较LTmv与无干预的随机试验，非步态干预，或者低强度步态训练。舒适的步态速度（CGS），最快的步态速度（FGS），6分钟步行测试（6MWT），步行活动（每天步数），并提取不良反应/事件(AE)数据。计算了平均变化的汇总估计值，AE相对风险，以及对LTmv与对照组的反应标准偏差(SDresponse)，尽可能按研究慢性分层。
结果：有19项符合条件的研究（总N=1096）：14项慢性卒中（N=839）和5项亚急性卒中（N=257）。与控制干预相比，LTmv在CGS中产生了显著更大的增加(慢性，+0.06m/s[95%置信区间(CI)，0.01-0.10]；亚急性，+0.16[0.12-0.19]；亚急性与慢性，P=0.03),FGS（慢性，+0.07m/s[0.02-0.13]；亚急性，+0.21[0.01,0.41];P=0.04),和6MWT(慢性，+33米[24-42]；亚急性，+51[26-77];P=0.054)但不是步数/天(+260[-1159至1679])。在14项AE报告研究中，398名LTmv参与者中没有出现与治疗相关的严重AE。SDresponse估计值表明相当大的响应变异性：CGS，0.11m/s[0.00-0.15];FGS,0.14m/s[-0.00至0.20]；和6MWT，41米[27-51]。
结论：LTmv改善了亚急性和慢性卒中的平均步行能力，似乎没有严重伤害的高风险。响应幅度在慢性亚组内部和之间变化，很少有研究测试对日常步行活动或非严重不良事件的影响。视频摘要可从作者那里获得更多见解(请参阅视频，补充数字内容1可在http://链接上获得。www.com/JNPT/A452)。
方法：在数据库中搜索比较LTmv与无干预的随机试验，非步态干预，或者低强度步态训练。舒适的步态速度（CGS），最快的步态速度（FGS），6分钟步行测试（6MWT），步行活动（每天步数），并提取不良反应/事件(AE)数据。计算了平均变化的汇总估计值，AE相对风险，以及对LTmv与对照组的反应标准偏差(SDresponse)，尽可能按研究慢性分层。
结果：有19项符合条件的研究（总N=1096）：14项慢性卒中（N=839）和5项亚急性卒中（N=257）。与控制干预相比，LTmv在CGS中产生了显著更大的增加(慢性，+0.06m/s[95%置信区间(CI)，0.01-0.10]；亚急性，+0.16[0.12-0.19]；亚急性与慢性，P=0.03),FGS（慢性，+0.07m/s[0.02-0.13]；亚急性，+0.21[0.01,0.41];P=0.04),和6MWT(慢性，+33米[24-42]；亚急性，+51[26-77];P=0.054)但不是步数/天(+260[-1159至1679])。在14项AE报告研究中，398名LTmv参与者中没有出现与治疗相关的严重AE。SDresponse估计值表明相当大的响应变异性：CGS，0.11m/s[0.00-0.15];FGS,0.14m/s[-0.00至0.20]；和6MWT，41米[27-51]。
结论：LTmv改善了亚急性和慢性卒中的平均步行能力，似乎没有严重伤害的高风险。响应幅度在慢性亚组内部和之间变化，很少有研究测试对日常步行活动或非严重不良事件的影响。视频摘要可从作者那里获得更多见解(请参阅视频，补充数字内容1可在http://链接上获得。www.com/JNPT/A452)。
