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Cycling for walking after stroke?

Regaining the ability to walk is one of the most important goals for people with mobility impairments e.g. after stroke. For this reason, recovery of walking capacity is a major objective in neurorehabilitation when motor impairments of the lower extremities strongly restrict the mobility of the patient. Because of certain similarities with walking, cycling leg exercise might be a beneficial rehabilitation method in sense of an additional therapy intervention next to intensive task practice.

 

The picture above, adapted from Zeher et al., shows the similarity of walking and cycling movement patterns. 

 

To get more clearness about overall effects I conducted a rapid meta-analysis that quantifies the benefits of lower limb cyclic movement therapy on walking capacity in patients with mobility impairments. 

 

Based on post intervention outcomes (Means and SDs) of five included studies, I calculated the individual effect sizes and their 95% confidence intervals. To determine statistical consistency (between-study variation) I used the I-Square statistic. An I-Square of 50.0% considers to reflect substantial heterogeneity. But as we can see below there is no significant variation between the study effects (I-Square = 0%). So I decided to apply a fixed-effects model. Strictly speaking it is incorrect to do this. But knowing that a random-effects model calculation (only in absence of heterogeneity!) would show me the same results , it didn't really matter to take that further into account.

 

 

Coming to the results: I included 5 trials with a total number of 161 participants and found evidence that the use of a cyclic movement trainer seems to be a beneficial adjunct to physiotherapy to improve walking capacity in patients with mobility impairments.

 

The pooled mean difference for walking capacity was about 41.71 meters, walked in six minutes (95% CI 23.86 to 59.56; P = <0.00001; level of heterogeneity I² = 0%). 

What is the clinical implication? This meta-analysis provides evidence that the use of cyclic movement trainer therapy in combination with physiotherapy increases walking capacity in people with mobility impairments. The intervention should be applied much as possible in order to support the clinical outcome of the patient effectively. 

 

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