Abstract
Objective
To evaluate the longer-term effects of electromechanical gait trainers (GTs) combined
with conventional physiotherapy on health status, function, and ambulation in people
with subacute stroke in comparison with conventional physiotherapy given alone.
Design
Randomized controlled trial with intention-to-treat analysis.
Setting
Community hospital in Singapore.
Participants
Nonambulant individuals (N=106) recruited approximately 1 month poststroke.
Interventions
Both groups received 45 minutes of physiotherapy 6 times per week for 8 weeks as follows:
the GT group received 20 minutes of GT training and 5 minutes of stance/gait training
in contrast with 25 minutes of stance/gait training for the control group. Both groups
completed 10 minutes of standing and 10 minutes of cycling.
Main Outcome Measures
The primary outcome was the Functional Ambulation Category (FAC). Secondary outcomes
were the Barthel Index (BI), gait speed and endurance, and Stroke Impact Scale (SIS).
Measures were taken at baseline and 4, 8, 12, 24, and 48 weeks.
Results
Generalized linear model analysis showed significant improvement over time (independent
of group) for the FAC, BI, and SIS physical and participation subscales. However,
no significant group × time or group differences were observed for any of the outcome
variables after generalized linear model analysis.
Conclusions
The use of GTs combined with conventional physiotherapy can be as effective as conventional
physiotherapy applied alone for people with subacute stroke.
Keywords
List of abbreviations:
BI (Barthel Index), FAC (Functional Ambulation Category), GT (gait trainer), SIS (Stroke Impact Scale)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Effects of task-oriented circuit training on walking competency after stroke: a systematic review.Stroke. 2009; 40: 2450-2459
- Gait training combining partial body–weight support, a treadmill, and functional electrical stimulation: effects on post-stroke gait.Phys Ther. 2007; 87: 1144-1154
- What is the evidence for physical therapy post-stroke? A systematic review and meta-analysis.PLoS One. 2014; 9: e87987
- Treadmill training and body weight support for walking after stroke.Cochrane Database Syst Rev. 2005; : CD002840
- Weight-supported treadmill training.Neurorehabil Neural Repair. 1999; 13: 167-169
- Can we improve gait skills in chronic hemiplegics? A randomised control trial with gait trainer.Eura Medicophys. 2007; 43: 499-504
- Effects of intensive therapy using gait trainer or floor walking exercises early after stroke.J Rehabil Med. 2009; 41: 166-173
- Repetitive locomotor training and physiotherapy improve walking and basic activities of daily living after stroke: a single blind, randomised multicentre trial.Clin Rehabil. 2007; 21: 17-27
- Improved walking ability and reduced therapeutic stress with an electromechanical gait device.J Rehabil Med. 2009; 41: 734-739
- A pilot study of randomized clinical controlled trial of gait training in subacute stroke patients with partial body-weight support electromechanical gait trainer and functional electrical stimulation: six-month follow up.Stroke. 2008; 39: 154-160
- The effectiveness of body weight-supported gait training and floor walking in patients with chronic stroke.Arch Phys Med Rehabil. 2005; 86: 1557-1564
- Treadmill training with partial body weight support and an electromechanical gait trainer for restoration of gait in subacute stroke patients: a randomised cross-over study.Stroke. 2002; 33: 2895-2901
- Multicenter randomised clinical trial evaluating the effectiveness of the Lokomat in subacute stroke.Neurorehabil Neural Repair. 2013; 23: 5-13
- Effects of locomotion training with assistance of a robot-driven gait orthosis in hemiparetic patients after stroke: a randomised controlled pilot study.Stroke. 2007; 38: 349-354
- Prospective, blinded, randomised crossover study of gait rehabilitation in stroke patients using the Lokomat gait orthosis.Neurorehabil Neural Repair. 2007; 21: 307-314
- The effectiveness of locomotor therapy using robotic-assisted gait training in subacute stroke patients: a randomised controlled trial.PMR. 2009; 1: 516-523
- Enhanced gait-related improvements after therapist- versus robotic-assisted locomotor training in subjects with chronic stroke - a randomized controlled study.Stroke. 2008; 39: 1786-1792
- Overground and robotic-assisted locomotor training in adults with chronic stroke: a blinded randomised clinical trial.Disabil Rehabil Assist Technol. 2013; 8: 161-168
- Pilot study of Lokomat versus manual-assisted treadmill training for locomotor recovery post-stroke.J Neuroeng Rehabil. 2009; 6: 18
- Evidence for the effectiveness of walking training on walking and self-care after stroke: a systematic review and meta-analysis of randomized controlled trials.J Rehabil Med. 2014; 46: 387-399
- Electromechanical-assisted training for walking after stroke.Cochrane Database Syst Rev. 2013; 7: CD006185
- Clinical gait assessment in the neurologically impaired. Reliability and meaningfulness.Phys Ther. 1984; 64: 35-40
- Functional abilities after stroke: measurement, natural history and prognosis.J Neurol Neurosurg Psychiatry. 1987; 50: 177-182
- Two, six and twelve minute walking tests in respiratory disease.BMJ. 1982; 284: 1604-1608
- The stroke impact scale 3.0: evaluation of acceptance, reliability, and validity of the Brazilian version.Stroke. 2008; 39: 2477-2484
- Physical and social functioning after stroke: comparison of the stroke impact scale and short form-36.Stroke. 2003; 34: 488-493
- Medical statistics.2nd ed. Blackwell Science, London2003
Article info
Publication history
Published online: January 20, 2016
Footnotes
Current affiliation for Culpan, School of Health Sciences, Queen Margaret University, Edinburgh, UK.
Supported by St Andrew's Community Hospital.
Disclosures: none.
Identification
Copyright
© 2016 The American Congress of Rehabilitation Medicine.