Jaffe 2004

Methods	RCT
Participants	Recruited from community stroke association meetings in California, USA 20 participants: 10 intervention, 10 control Inclusion criteria: more than 6 months post stroke with a diagnosis of hemiplegia secondary to single documented lesion, walks independently or with an aid and has an asymmetric gait pattern and short step‐length with either step (< 95th percentile of normal step length), scores representing average or minimally impaired in all Cognistat categories unless performance was markedly limited by aphasia making assessment of cognition difficult Exclusion criteria: neurological diagnoses of spinal cord injury, multiple sclerosis or brainstem lesion; any progressive critical or long‐term illness or unstable cardiovascular, orthopaedic, musculoskeletal or neurological condition that would preclude exercise or is not controlled by medication or requires oxygen during ambulation Mean (SD) age: intervention group 58 (11) years, control group 63 (8) years 60% male Stroke details: 50% right hemiparesis Timing post stroke: intervention group 4 years (SD 2), control group 4 years (SD 3)
Interventions	Virtual reality intervention: participants walked on a treadmill at a self selected walking speed and were secured by an overhead harness. The participant wore a head‐mounted display that showed real‐time video images of their feet walking and virtual objects. The participant was asked to step over the virtual objects and visual, vibrotactile and auditory feedback was provided during any collisions Control intervention: participants wore a gait belt and stepped over foam obstacles in a hallway. The sessions were videotaped and reviewed for collisions with the obstacles after the session was completed Sessions were approximately 60 minutes, for 6 sessions over 2 weeks (6 hours total)
Outcomes	Outcomes recorded at baseline, post‐intervention and 2 weeks post‐intervention Lower limb function and activity outcomes: 6‐metre walk test, obstacle test, 6‐minute walk test, the researcher's own balance test (adapted from others) that included natural stance, eyes close, on toes, tandem stance, left and right leg stand Adverse events reported
Notes	—
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	An Excel spreadsheet was generated with a pre‐determined computerised randomisation sequence
Allocation concealment (selection bias)	High risk	The allocation in the spreadsheet was not visible due to black font and black background shading; however, there is the possibility that staff with access to the spreadsheet could have checked this
Blinding of outcome assessment (detection bias) All outcomes	Low risk
Incomplete outcome data (attrition bias) All outcomes	Low risk	No outcome data were missing (according to personal correspondence with the researcher)
Selective reporting (reporting bias)	Unclear risk	Unclear ‐ not privy to protocol