Effects of body weight-supported treadmill training with or without electrical stimulation on functional ambulation in patients with spinal cord injury: A systematic review and meta-analysis

Earlier studies on body-weight supported treadmill training (BWSTT) for spinal cord injury (SCI) show potential benefits, particularly in improving locomotor function. However, most evidence comes from small studies, necessitating a systematic review to assess its overall impact and acceptability. This review aims to investigate and quantitatively synthesize evidence on the impact of BWSTT, with or without electrical stimulation (FES/ES), on ambulation in individuals with incomplete spinal cord injuries (iSCI) compared to overground gait training or traditional physiotherapy. A bibliographic extensive search for clinical trials involving adults with traumatic spinal cord injury (TSCI) lesions (AISA impairment scale of B, C or D) that compared BWSTT with or without electrical stimulation with overground gait training or traditional physiotherapy was conducted. The end results were walking functionality (walking speed and capacity) and functional independence. BWSTT with FES/ES was analyzed independently, and trial-by-trial data were combined to calculate the mean across group differences via a model with random/fixed effects. Twelve randomized controlled trials (RCTs) were included for qualitative synthesis, whereas nine studies were analyzed for quantitative data. BWSTT as locomotor approach for individual with incomplete SCI did not significantly improve walking speed (MD: − 0.02, 95% CI, − 0.09 to 0.06, p=0.45), nor did it improve walking capacity (MD: 16.28, 95% CI, -26.27 to 58.82, p=0.05), FIM score, WISCI, LEMS, and balance. Similarly, BWSTT combined FES/ES and the control group showed no statistically significant differences in walking speed or capacity. BWSTT, whether used alone or in combination with FES/ES, does not provide a statistically significant advantage over other forms of physical rehabilitation for improving walking function, speed, capacity, balance, or functional independence in people with iSCI.