The Effect of Split-Belt Treadmill Interventions on Step Length Asymmetry in Individuals Poststroke: A Systematic Review With Meta-Analysis.

Background: Individuals poststroke experience gait asymmetries that result in decreased community ambulation and a lower quality of life. A variety of studies have utilized split-belt treadmill training to investigate its effect on gait asymmetry, but many employ various methodologies that report differing results.
Objective: The purpose of this meta-analysis was to determine the effects of split-belt treadmill walking on step length symmetry in individuals poststroke both during and following training.
Methods: A comprehensive search of PubMed/MEDLINE, CINAHL, Web of Science, and Scopus was conducted to find peer-reviewed journal articles that included individuals poststroke that participated in a split-belt treadmill walking intervention. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) was used to assess risk of bias. Pooled Hedge's g with random effects models were used to estimate the effect of split-belt training on step length symmetry.
Results: Twenty-one studies were assessed and included in the systematic review with 11 of them included in the meta-analysis. Included studies had an average STROBE score of 16.2 ± 2.5. The pooled effects for step length asymmetry from baseline to late adaptation were not significant ( g = 0.060, P = .701). Large, significant effects were found at posttraining after a single session ( g = 1.04, P < .01), posttraining after multiple sessions ( g = -0.70, P = .01), and follow-up ( g = -0.718, P = .023).
Conclusion: Results indicate split-belt treadmill training with the shorter step length on the fast belt has the potential to improve step length symmetry in individuals poststroke when long-term training is implemented, but randomized controlled trials are needed to confirm the efficacy of split-belt treadmill training.