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“Although

the majority of individuals achieve an independent gait after stroke, many do not reach a walking level that enables them to perform all their daily activities (Flansbjer et al 2005). Typically, the mean walking speed for the majority of community-dwelling people after stroke ranges from 0.4 m/s to 0.8 m/s (Duncan et al 1998, Eng et al 2002, Green et al 2002, Pohl et al 2002, Ada et al 2003). This slow speed frequently prevents their full participation in community activities. Additionally, people report a lack of ability Temozolomide cost to cover long distances after stroke, restricting their participation in work and social activities (Combs et al 2012). Moreover, walking ability has been found Ruxolitinib order to be related to community

participation (Robinson 2011). While the goal of inpatient rehabilitation is independent and safe ambulation, once individuals return home, rehabilitation aims to enhance community ambulation skills by increasing walking speed and endurance. Lord et al (2004) found that the ability to confidently negotiate uneven terrain, private venues, malls and other public venues is the most relevant predictor of community ambulation. Therefore, in order to enhance community participation, rehabilitation has focused on identifying the best approach to optimise walking speed and walking distance. One approach to improving gait is the use of mechanically assisted walking devices, such as treadmills or gait trainers. Two Cochrane systematic reviews have examined

these devices separately: Moseley et al (2005) reported on treadmill training and Mehrholz (2010) examined electromechanically-assisted training. We wanted to examine all devices that will help improve walking in the one review. In ambulatory stroke, mechanically assisted walking, whether by treadmills or gait trainers, allows an intensive amount of stepping practice by working as a ‘forced use’. Mechanically assisted walking also facilitates the practice of a more normal walking pattern because it forces appropriate timing between lower limbs, promotes hip extension during the stance phase of walking and discourages common compensatory behaviours Cell press such as circumduction (Harris-Love et al 2001, Ada et al 2003, Moore et al 2010). We have already taken this approach in What is already known on this topic: Mechanically assisted walking training, which can involve interventions such as treadmill training or electromechanical gait trainers, increases independent walking among people who have been unable to walk after stroke. However, previous systematic reviews have not drawn clear conclusions about the effect of treadmill training or gait trainers among ambulatory stroke survivors specifically. What this study adds: Compared with no intervention or with an intervention with no walking training component, treadmill training improved walking speed and distance among ambulatory people after stroke.