Body weight-supported treadmill training is no better than overground training for individuals with chronic stroke: a randomized controlled trial

Abstract

Background: Body weight-supported treadmill training (BWSTT) has produced mixed results compared with other therapeutic techniques.

Objective: The purpose of this study was to determine whether an intensive intervention (intensive mobility training) including BWSTT provides superior gait, balance, and mobility outcomes compared with a similar intervention with overground gait training in place of BWSTT.

Methods: Forty-three individuals with chronic stroke (mean [SD] age, 61.5 [13.5] years; mean [SD] time since stroke, 3.3 [3.8] years), were randomized to a treatment (BWSTT, n = 23) or control (overground gait training, n = 20) group. Treatment consisted of 1 hour of gait training; 1 hour of balance activities; and 1 hour of strength, range of motion, and coordination for 10 consecutive weekdays (30 hours). Assessments (step length differential, self-selected and fast walking speed, 6-minute walk test, Berg Balance Scale [BBS], Dynamic Gait Index [DGI], Activities-specific Balance Confidence [ABC] scale, single limb stance, Timed Up and Go [TUG], Fugl-Meyer [FM], and perceived recovery [PR]) were conducted before, immediately after, and 3 months after intervention.

Results: No significant differences (α = 0.05) were found between groups after training or at follow-up; therefore, groups were combined for remaining analyses. Significant differences (α = 0.05) were found pretest to posttest for fast walking speed, BBS, DGI, ABC, TUG, FM, and PR. DGI, ABC, TUG, and PR results remained significant at follow-up. Effect sizes were small to moderate in the direction of improvement.

Conclusions: Future studies should investigate the effectiveness of intensive interventions of durations greater than 10 days for improving gait, balance, and mobility in individuals with chronic stroke.

Keywords: balance; gait; mobility; rehabilitation; stroke; treadmill training.

Conflict of interest statement

Conflicts of interest: The authors have no conflicts of interest to report.

Figures

Figure 1

Delivery of treatment components by group. BWSTT = body weight–supported treadmill training; ROM = range of motion.

Figure 2

Consolidated Standards of Reporting Trials (CONSORT) diagram showing flow of participants through each stage of this randomized trial. *Participants screened and randomly assigned to groups because of initial interest but unable to participate because of scheduling, transportation, or personal or family health issues. Intervention not initiated.

Figure 3

Changes across testing sessions represented as percentages of total possible score. ABC = Activities-specific Balance Confidence Scale; Base = baseline assessment period; BBS = Berg Balance Scale; DGI = Dynamic Gait Index; FM-LE = Fugl-Meyer Lower Extremity subscale; Post = posttest assessment period; Pre = pretest assessment period; SIS = Stroke Impact Scale. Standard errors for included outcome measures are presented in Table 3.

Figure 4

Percentage of participants meeting or exceeding minimal detectable change (MDC). MDCs for included outcome measures are presented in Table 2 (Methods). 3WMT = 3-meter walk test; 6MWT = 6-minute walk test; ABC = Activities-specific Balance Confidence Scale; BBS = Berg Balance Scale; DGI = Dynamic Gait Index; FM-LE = Fugl-Meyer Lower Extremity subscale; SLS = single limb stance; TUG = Timed Up and Go.