Spine. 2008 Oct 1;33(21):E768-77.

Locomotor training for walking after spinal cord injury.

Mehrholz J, Kugler J, Pohl M.

Klinik Bavaria Kreischa und TU Dresden, Medizinische Fakultät, Germany. jan.mehrholz@klinik-bavaria.de

STUDY DESIGN: Systematic review. OBJECTIVE: To assess the effects of locomotor training on improvement in walking for people with traumatic spinal cord injury (SCI). METHODS: We searched the Cochrane Injuries Group Specialized Register (last searched June 2007); the Cochrane Central Register of Controlled Trials (The Cochrane Library 2007, Issue 2); MEDLINE (1966-June 2007); EMBASE (1980-June 2007); National Research Register (2007, Issue 2); CINAHL (1982-June 2007); Allied and Complementary Medicine Database (1985-June 2007); SPORTDiscus (1949-June 2007); the Physiotherapy Evidence database (searched June 2007); COMPENDEX (engineering databases) (1972-June 2007); INSPEC (1969- June 2007); and the National Research Register, Zetoc, and Current Controlled Trials research and trials registers. We also handsearched relevant conference proceedings, checked reference lists, and contacted study authors in an effort to identify published, unpublished and ongoing trials.We included randomized controlled trials (RCT) that compared locomotor training to any other exercise provided with the goal of improving walking function after SCI or to a no-treatment control group. Two review authors independently selected trials for inclusion, assessed trial quality and extracted the data. The primary outcomes were walking speed and walking capacity at follow-up. RESULTS: Four RCTs involving 222 patients were included in this review. Overall, the results were inconclusive. There was no statistically significant effect of locomotor training on walking function after SCI comparing bodyweight supported treadmill training with or without functional electrical stimulation or robotic-assisted locomotor training. CONCLUSION: There is insufficient evidence from RCTs to conclude that any 1 locomotor training strategy improves walking function more than another for people with SCI. Research in the form of large RCTs is needed to address specific questions about the type of locomotor training which might be most effective in improving walking function of people with SCI.