Systematic Review and Meta-Analysis of Treadmill Training Protocols in Chronic Stroke Patients

Objective: To systematically evaluate the effectiveness of treadmill-based gait training modalities on gait function in individuals with chronic stroke.Design: Systematic review and meta-analysis of randomized controlled trials.Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Embase were searched for randomized controlled trials (RCTs) published between 2020 and 2024.This focused temporal window was selected to capture contemporary technological innovations in treadmill-based rehabilitation, including virtual reality integration, dual-task paradigms, and physiological augmentation strategies, which represent a fundamentally different therapeutic landscape from earlier conventional treadmill protocols.Studies involving adult patients with chronic stroke receiving treadmill-based gait training (conventional, body weight-supported, or robotic-assisted) were included.The primary outcome was the analysis of gait function, including gait velocity, ambulatory endurance, and spatiotemporal parameters.The risk of bias was assessed using Cochrane RoB 2.0.Finally, pooled standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using random effects models.Results: Seven RCTs involving 190 participants were included.Between-group analysis revealed no significant differences between the treadmill and non-treadmill interventions (SMD = 0.27, 95% CI: -0.19-0.73,p = 0.25).Pre-post analysis showed moderate overall effects (SMD = 0.74, 95% CI: 0.24 to 1.25, p = 0.004, I = 80%).The subgroup analysis identified dual-task treadmill training as producing the largest effect (SMD = 1.26, p = 0.003), whereas general and high-intensity protocols did not show significant effects.Conclusions: Treadmill training demonstrated moderate effectiveness for gait rehabilitation in patients with chronic stroke, with dual-task training showing superior outcomes.However, treadmill training was not superior to overground walking.Future studies should prioritize standardized protocols and longer follow-up periods to expand upon these findings.