Body-Weight–Supported Treadmill Rehabilitation After Stroke

Study Questions:

Locomotor training, including the use of body-weight support in treadmill stepping, is a physical therapy intervention used to improve recovery of the ability to walk after stroke. Does outpatient locomotor training in a rehabilitation center improve post-stroke mobility greater than home physical therapy?

Methods:

A total of 408 participants who had a stroke 2 months earlier were stratified according to the extent of walking impairment—moderate (able to walk 0.4 to <0.8 m/sec) or severe (able to walk <0.4 m/sec)—and randomly assigned to one of three training groups: 1) rehab center training on a treadmill with the use of body-weight support 2 months after the stroke had occurred (early locomotor training); 2) rehab center locomotor training 6 months after the stroke had occurred (late locomotor training); and 3) a home exercise program managed by a physical therapist 2 months after the stroke (home exercise program). Each intervention included 36 sessions of 90 minutes each for 12-16 weeks. The primary outcome was the proportion of participants in each group who had an improvement in functional walking ability 1 year after the stroke.

Results:

Mean age was about 62 years, and greater than 50% were men. Mean time from stroke to randomization was 64 days. At 1 year, 52.0% of all participants had increased functional walking ability. No significant differences in improvement were found between early locomotor training and home exercise or between late locomotor training and home exercise. All groups had similar improvements in walking speed, motor recovery, balance, functional status, and quality of life. Neither the delay in initiating the late locomotor training nor the severity of the initial impairment affected the outcome at 1 year. As compared with the home exercise group, each of the groups receiving locomotor training had a higher frequency of dizziness or faintness during treatment (p = 0.008). Among patients with severe walking impairment, multiple falls were more common in the group receiving early locomotor training than in the other two groups (p = 0.02).

Conclusions:

The authors concluded that locomotor training, including the use of body-weight support in stepping on a treadmill, was not shown to be superior to progressive exercise at home managed by a physical therapist.

Perspective:

It is nice to see a study demonstrating that post-stroke home physical therapy, which is far less costly and so much easier for the stroke patient, is as good as a very expensive rehab center-based protocol. Hopefully, early stroke interventions will reduce the functional impairment post-stroke. Over 50% of the participants in this study could not walk 0.4 m/sec.

Clinical Topics: Prevention, Exercise

Keywords: Quality of Life, Rehabilitation Centers, Physical Therapists, Exercise Therapy, Physical Therapy Modalities


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