Treadmill training provides greater benefit to the subgroup of community-dwelling people after stroke who walk faster than 0.4m/s: a randomised trial

摘要

Question: After stroke, does treadmill training provide greater benefit to the subgroup of community-dwelling people who walk faster than 0.4 m/s than those who walk more slowly? Design: Subgroup analysis of a randomised trial: the AMBULATE trial. Participants: 68 people with stroke living in the community. Intervention: The experimental group received 30 minutes of treadmill and overground walking, three times a week for four months; the control group received no intervention. Outcome measures: The primary outcome was walking distance covered during the six-minute walk test. Other outcomes were comfortable and fast walking speed and health status. Results: At four months, in the subgroup of participants with a baseline comfortable walking speed of 0.4 m/s, treadmill training produced an extra distance of 72 m (95% CI 23 to 121) and an increased comfortable speed of 0.16 m/s (95% CI 0.00 to 0.32), compared with the subgroup with a speed of ≤ 0.4 m/s. There was also a trend towards an extra fast speed of 0.17 m/s (95% CI –0.04 to 0.36). There was no extra effect of treadmill training in the faster walkers in terms of EuroQol 5Q-5D. There were no differences between the experimental and control groups between subgroups in the long term. Conclusion: Treadmill training is more likely to benefit people who walk at a speed of 0.4 m/s. Clinicians should use comfortable walking speed to predict the potential for improvement and to guide intervention. Trial registration: ACTRN12607000227493. [Dean CM, Ada L, Lindley RI, (2014) Treadmill training provides greater benefit to the subgroup of community- dwelling people after stroke who walk faster than 0.4 m/s: a randomised trial. Journal of Physiotherapy 60: 97–101].