Effectiveness of Treadmill Training on Walking Ability in Adults with Cerebral Palsy: A Systematic Review and Meta-Analysis

Background: Patients with cerebral palsy (CP) may necessitate long-term treatment and monitoring of their condition, not only during the period of development but also during adulthood. Objectives: This systematic review aimed to analyze evidence from randomized controlled trials (RCTs) that have investigated the effect of treadmill training on walking ability in adults with cerebral palsy. Methods: RCTs were identified and selected systematically, with appropriate keywords applied in four scientific databases (Medline, Scopus, the Cochrane Library, and the Physiotherapy Evidence Database) and one bibliographic search engine (Google Scholar) from January 1980 to September 2021. Two assessors extracted and analyzed data from relevant RCTs published in English and then independently rated those studies for risk of bias with the Risk of Bias (RoB 2) tool. Results: Out of the 96 studies that were initially identified, 93 were excluded, as these either did not meet the inclusion criteria or were duplicates. Three clinical trials were finally included, characterized by some concerns and a high risk of bias (RoB 2). Meta-analysis was only performed for the maximum distance in the ‘6-minute walk for distance test’, due to differences in the remaining outcomes utilized between studies. Overall, there was evidence of some concerns and high risk of bias that treadmill training did not significantly improve the walking ability in adult patients with CP relative to the control conditions. Conclusion: More high-quality RCTs are required, examining the effectiveness of treadmill training on different aspects of walking ability such as gait speed, endurance, and energy expenditure.