Energy consumption and cost during walking with different modalities of assistance after stroke: a systematic review and meta-analysis.

Purpose:To estimate pooled rates of gross and net energy consumption (ml/kg/min and J/kg/min) and energy cost (ml/kg/m and J/kg/m) during level surface walking with different assistance modalities post-stroke. Materials and Methods:Four databases were searched using keywords related to stroke, walking, and energy requirements. Three independent reviewers screened 3296 records and included 42 studies in quantitative analysis. Results:Pooled rates without significant important heterogeneity were identified for: gross energy consumption during unassisted overground walking at comfortable walking speed (10.55 ml/kg/min; 95% CI [9.93-11.16]), gross energy consumption during treadmill walking with rigid exoskeleton assistance (7.08 ml/kg/min; 95% CI [6.52-7.65]), gross energy cost during unassisted overground walking in patients with chronic stroke (0.24 ml/kg/m; 95% CI [0.28-0.48]), gross energy cost during unassisted treadmill walking in patients with subacute stroke (0.45 ml/kg/m; 95% CI 0.45-0.45]), and net energy cost during overground walking with assistive devices and orthoses in patients with chronic stroke (4.12 J/kg/m, 95% CI [3.55-4.69]). Conclusions:Walking, unassisted and with the use of assistive devices and lower limb orthoses, induces low- to moderate-intensity exercise as recommended by exercise guidelines for stroke survivors. Future studies should explore whether bodyweight-supported or robot-assisted walking can also reach moderate-intensity.