Mirelman 2008

Methods	RCT
Participants	Study took place in New Jersey, USA 18 participants: 9 intervention, 9 control Inclusion criteria: chronic hemiparesis after stroke with residual gait deficits, partial antigravity dorsiflexion, able to walk 50 feet without the assistance of another person, sufficient communication and cognitive ability to participate Exclusion criteria: motion sickness and receiving concurrent therapy Mean (SD) age: intervention group 62 (10) years, control group 61 (8) years 83% male Stroke details: 44% right hemiparesis Timing post stroke: intervention group mean (SD) 38 (25) months, control group 58 (26) months
Interventions	Virtual reality intervention: Rutgers ankle rehabilitation system (a 6 degree of freedom platform force‐feedback system) that allows participants to exercise the lower extremity by navigating through a virtual environment displayed on a desktop computer. Participants executed the exercises by using the foot movements to navigate a plane or a boat through a virtual environment that consisted of a series of targets Control intervention: Rutgers ankle rehabilitation system without the virtual environment. Participants were instructed by the therapist on which direction to move their foot and were paced by a metronome cueing them to complete a comparable number of repetitions Sessions were 60 minutes, 3 times a week for 4 weeks (12 hours total)
Outcomes	Outcomes recorded at baseline, post‐intervention and at 3 months Lower limb function and activity outcomes: gait speed over 7‐metre walkway, 6‐minute walk test, Patient Activity Monitor (distance walked, number of steps per day, average speed, step length, top speed)
Notes	—
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Randomisation was performed based on the table of numbers method (generated by a computer)
Allocation concealment (selection bias)	Low risk	Allocation was done by an external person to the project and held in a database spreadsheet on a computer in his office which was password protected
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Blind
Incomplete outcome data (attrition bias) All outcomes	Low risk	1 participant in the robotic‐virtual reality group was lost to follow‐up because of personal reasons. 1 outlier was identified in the robotic‐virtual reality group following the descriptive analysis of the endurance test (6MWT), the values presented for this individual were 2 SD from the mean therefore he was excluded from the analysis
Selective reporting (reporting bias)	Low risk	No other outcomes were collected