For stroke victims, at-home strength and balance exercises provided by a physical therapist work just as well in regaining walking ability as participating in the actual task of walking through the use of a treadmill and partial body weight support, according to a study published in the New England Journal of Medicine.
Furthermore, patients continued to make improvements during therapy up to one year after a stroke, longer than typically expected.
“For individuals who have suffered a stroke, the findings of this trial offer good news for improving walking within the first year post-stroke through intense physical therapy interventions,” said Andrea Behrman, Ph.D., co-principal investigator and an associate professor in the department of physical therapy at the University of Florida College of Public Health and Health Professions.
“For therapists and physicians, the study informs us of the merit of two rehabilitation strategies for improving walking — one via practice of walking and the other via strengthening and balance training — and who will benefit and when to deliver the intervention.”
The trial, called the Locomotor Experience Applied Post-Stroke (LEAPS), included more than 400 patients who were randomly assigned to either a home-based therapy group or a treadmill training group two or six months after their stroke.
The home-based therapy group was supervised by a physical therapist and focused on flexibility, range of motion, strength and balance. Those in the walking group practiced walking using a treadmill that provided partial body-weight support, also known as locomotor training, in a clinic setting.
At the one-year mark, 52 percent of all the study participants had made significant improvements in their walking ability. Both the exercise program and the walking training patients had similar improvements in walking speed, motor recovery, balance, social participation and quality of life.
However, the at-home exercise program may save on health-care costs and promote treatment follow-through: Only 3 percent of patients in the home-based therapy dropped out of the study compared to 13 percent who discontinued the locomotor training.
“We were pleased to see that stroke patients who had a home physical therapy exercise program improved just as well as those who did the locomotor training. The home physical therapy program is more convenient and pragmatic. Usual care should incorporate more intensive exercise programs that are easily accessible to patients to improve walking, function and quality of life,” said Pamela W. Duncan, Ph.D., the study’s principal investigator and a professor at Duke University School of Medicine.
Furthermore, patients in the group who began the therapy six months after their stroke also improved their walking. Researchers say this finding challenges the widely held belief that patients can only make gains in their rehabilitation within the first few months of a stroke.
“More than 4 million stroke survivors experience difficulty walking. Rigorously comparing available physical therapy treatments is essential to determine which is best,’’ said Dr. Walter Koroshetz, deputy director of the National Institute of Neurological Disorders and Stroke.
“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 National Institute of Neurological Disorders and Stroke provided primary funding for the study.
Source: University of Florida