In the largest stroke rehabilitation study ever conducted in the United States, stroke patients who had physical therapy at home improved their ability to walk just as well as those who were treated in a training program that requires the use of a body-weight supported treadmill device followed by walking practice.
The study, funded by the National Institutes of Health, also found that patients continued to improve up to one year after stroke, defying conventional wisdom that recovery occurs early and tops out at six months. In fact, even patients who started rehabilitation as late as six months after stroke were able to improve their walking.
The results of the study will be published in the May 26, 2011 edition of the New England Journal of Medicine.
“More than 4 million stroke survivors experience difficulty walking. Rigorously comparing available physical therapy treatments is essential to determine which is best,” said Walter Koroshetz, M.D., NINDS deputy director. “The results of this study show that the more expensive, high tech therapy was not superior to intensive home strength and balance training, but both were better than lower intensity physical therapy.”
The walking program involves having a patient walk on a treadmill in a harness that provides partial body weight support. This form of rehabilitation, which is known as locomotor training, has become increasingly popular. After the patients complete their training on the treadmill, they practice walking.
Previous studies suggested that these devices, also called commercial lifts or robot-assisted treadmill steppers, are an effective intervention in helping stroke patients walk. But this walking program had not been tested on a large scale or examined in terms of the most appropriate timing for therapy.
The investigators of the Locomotor Experience Applied Post-Stroke (LEAPS) trial set out to compare the effectiveness of the body-weight supported treadmill training with walking practice started at two different stages–two months post-stroke (early locomotor training) and six months post-stroke (late locomotor training). The locomotor training was also compared against an equivalent schedule of home exercise managed by a physical therapist, aimed at enhancing patients’ flexibility, range of motion, strength and balance as a way to improve their walking. The primary measure was each group’s improvement in walking at one year after the stroke.
The investigators had hypothesized that the body-weight supported treadmill and walking program, especially early locomotor training, would be superior to a home exercise program. However, they found that all groups did equally well, achieving similar gains in walking speed, motor recovery, balance, social participation and quality of life.
The study found that both the locomotor training and the home physical therapy were superior to usual care. Usual care should incorporate more intensive exercise programs that are easily accessible to patients to improve walking, function and quality of life.”