http://www.mdlinx.com/neurology/xml-article.cfm/3620131
Duncan PW et al. – 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.
Methods
- The authors stratified 408 participants who had had a stroke 2 months earlier according to the extent of walking impairment — moderate (able to walk 0.4 to <0.8 m per second) or severe (able to walk <0.4 m per second) — and randomly assigned them to one of three training groups.
- One group received training on a treadmill with the use of body-weight support 2 months after the stroke had occurred (early locomotor training), the second group received this training 6 months after the stroke had occurred (late locomotor training), and the third group participated in an exercise program at home managed by a physical therapist 2 months after the stroke (home-exercise program).
- Each intervention included 36 sessions of 90 minutes each for 12 to 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.
- 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 (adjusted odds ratio for the primary outcome, 0.83; 95% confidence interval [CI], 0.50 to 1.39) or between late locomotor training and home exercise (adjusted odds ratio, 1.19; 95% CI, 0.72 to 1.99).
- 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.
- Ten related serious adverse events were reported (occurring in 2.2% of participants undergoing early locomotor training, 3.5% of those undergoing late locomotor training, and 1.6% of those engaging in home exercise).
- 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).
No comments:
Post a Comment