A Comparison of Two Intensive Walking Training Interventions in Community Dwelling Individuals With History of Stroke
A Motor Learning Based Walking Program Versus Body Weight Supported Treadmill Training in Community Dwelling Adults Within One Year of Stroke Onset: A Randomized Controlled Trial
Stroke is a major cause of disability in Canadian adults. Following a stroke, many people have difficulty walking in their home and in the community. The purpose of this study is to compare the effect of two different approaches to walking retraining in people who have had a stroke.
Individuals living in the community who have had recently had a stroke will be asked to participate in this study. Participants will be randomly assigned to one of two five week walking training programs. In one program, individuals will re-learn to walk in a variety of real-life situations. Practice sessions will encourage active problem solving by the participants. The other program will have participants practice walking on a treadmill while some of their body weight is supported by a special harness system. Participants will also be assisted by a physiotherapist to walk in a more normal manner.
Participants' will be assessed at the beginning of the study, after the 5 week training program and again, eight weeks later. The research assistant will assess their ability to walk, their confidence level and the average daily walking activity.
Primary Hypothesis: Individuals assigned to the Motor Learning Walking Program will improve their walking ability from baseline to follow up assessment significantly more than individuals assigned to the Treadmill Training Program.
The results of this study will help physiotherapists plan effective treatment programs for individuals with walking difficulties following stroke. It will also give researchers direction for future studies in the areas of walking retraining and motor skill development post-stroke.
Aperçu de l'étude
Statut
Les conditions
Intervention / Traitement
Type d'étude
Inscription (Réel)
Phase
- Phase 2
Contacts et emplacements
Lieux d'étude
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Ontario
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Hamilton, Ontario, Canada, L8N 4A6
- St. Joseph's Healthcare Hamilton
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Critères de participation
Critère d'éligibilité
Âges éligibles pour étudier
Accepte les volontaires sains
Sexes éligibles pour l'étude
La description
Inclusion Criteria:
- Stroke onset within previous 12 months
- Age 40 or older
- Able to follow 2 step verbal command (English),
- Able to walk 10 metres without human assistance (may use walking aid)
- Independent community ambulatory prior to stroke
- Community dwelling
- Approval from physician for participation in study
Exclusion Criteria:
- Walking speed greater than 1.0 m/s without walking aid
- Within normal limits on Modified Mini Mental Status test (age and education adjusted)
- Documented global aphasia
- Legal blindness
- Unable to exercise due to the any of the following conditions
- A recent significant change in resting ECG suggesting ischemia
- Recent Myocardial infarction (within 3 months) or other acute cardiac event
- Unstable angina
- Severe SOB at rest or with activities of daily living
- Uncontrolled cardiac arrhythmias causing symptoms
- Severe symptomatic aortic stenosis
- Uncontrolled symptomatic heart failure
- Acute pulmonary embolus or pulmonary infarction
- Acute myocarditis or pericarditis
- Suspected or known dissecting aneurysm
- Acute systemic infection, accompanied by fever, body ache or swollen lymph glands
- Uncontrolled hypertension (systolic > 200 mmHg, diastolic > 110 mmHg )
- Severe peripheral vascular disease with sustained claudication (resulting in limited walking tolerance)
- Severe lower extremity orthopedic problems with severe pain on weight bearing
- Lower extremity amputation that requires prosthesis
Plan d'étude
Comment l'étude est-elle conçue ?
Détails de conception
- Objectif principal: Traitement
- Répartition: Randomisé
- Modèle interventionnel: Affectation parallèle
- Masquage: Seul
Armes et Interventions
Groupe de participants / Bras |
Intervention / Traitement |
|---|---|
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Expérimental: Motor Learning Walking Program
Motor Learning principles based Walking Program (MLWP) Participants practice variety of real life over ground walking related activities.
Order of practice, instructions, guidance and feedback are provided in a manner that facilitates cognitive engagement of learner.
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Motor Learning principles based Walking Program (MLWP) Participants practice variety of real life over ground walking related activities.
Order of practice, instructions, guidance and feedback are provided in a manner that facilitates cognitive engagement of learner.
Sessions 45 minutes, 3x per week over 5 weeks for a total of 15 sessions
Autres noms:
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Comparateur actif: Body weight supported treadmill training
Body Weight Supported Treadmill Training.
Participants walk on a treadmill while partially supported with an overhead harness system.
Mass repetition of the normal gait cycle is encouraged through the support of the harness, the movement of the treadmill, and the assistance of one or two trainers to position limbs and trunk.
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Participants practice walking on a treadmill while supported with an overhead harness system.
Up to 40% body weight support.
Target Treadmill speed 2.0 mph. 1 or 2 Trainers (at least one Physical Therapist plus another Physical Therapist or Physiotherapy Assistant) will help guide participants leg, foot and trunk during treatment.
Aim is to practice high numbers of repetition of the normal gait cycle on treadmill.
Duration of sessions - 20 minutes of treadmill training within a 45 minute session ( 4 sets of 5 minutes of training with 5 minute rests).
3 sessions per week for 5 weeks.
Total of 15 sessions.
Autres noms:
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Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Délai |
|---|---|
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Self selected over ground gait speed - 5 metre walk test
Délai: 8 week follow up
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8 week follow up
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Mesures de résultats secondaires
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
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Six Minute Walk Test
Délai: Post Intervention and 8 week follow up
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Post Intervention and 8 week follow up
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Self selected over ground gait speed - 5 metre walk test
Délai: Post Intervention
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Post Intervention
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Balance related Self Efficacy - Activities-specific Balance Confidence Scale
Délai: Post intervention and 8 week follow up
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Post intervention and 8 week follow up
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Average Daily Step Count - StepWatch 3 Step Activity Monitor
Délai: Post Intervention and 8 Week Follow up
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Post Intervention and 8 Week Follow up
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Dynamic Balance - Functional Balance Test
Délai: Baseline, Post-intervention and 8 week Follow-up
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Over a 9 m track - participants are required to perform 5 balance and walking related tasks. Participants are required to 1) rise from a chair, walk 3 m, 2) step up and down an 8 inch step, walk 3 m, 3) bend down to pick up and return a 2.5 kilo weight off floor, walk 3 m to marked spot on the floor, 4) turn 180 degrees and walk 9 m back to the chair, 5. sit back down in the chair. Each task is scored on a 4 point scale (total score of out 20) Participants are timed on how long it takes them to perform the entire circuit. |
Baseline, Post-intervention and 8 week Follow-up
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Life Space Questionnaire
Délai: Baseline, Post-intervention, and at 8 week follow up
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Self-report measure of mobility partipation.
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Baseline, Post-intervention, and at 8 week follow up
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Number of trainers required per treatment session
Délai: Documented at every treatment session for both experimental and active comparison interventions.
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Documented at every treatment session for both experimental and active comparison interventions.
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Patient Specific Functional Scale
Délai: Baseline, Post-intervention, Follow-up (8weeks)
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In this measure, participants are asked to identify 3 walking related functional activities that they currently have some difficulty performing and would like to improve with treatment. For each activity, the participant rates their current ability to perform the task on a numeric rating scale of 0 to 10. At Post-intervention and Follow-up, participants re-rate their current ability on the same activites (without seeing their previous score). |
Baseline, Post-intervention, Follow-up (8weeks)
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Rating of Walking functional level - Modified Functional Walking Categories
Délai: Baseline, Post-intervention, Follow-up (8 weeks)
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Baseline, Post-intervention, Follow-up (8 weeks)
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Adverse event - Self-report of a fall(s) since baseline assessment
Délai: Post Intervention Assessment
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Participants will be asked whether or not they have had a fall since baseline assessment.
Details of the fall(s) will be recorded.
Fall report based on participant recall - no other tools (e.g.
diary) will be used.
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Post Intervention Assessment
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Adverse event - Falls (yes or no)
Délai: Follow - up - 8 weeks after post-intervention assessment
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Participant asked to report whether or not they had a fall since Post Intervention assessment. Details of the fall will be provided. Based on participant recall - no other tools for falls recording will be used (ie. will not be using falls diary) |
Follow - up - 8 weeks after post-intervention assessment
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Serious adverse events - ie. new stroke, myocardial infarction, overnight hospital admission, death
Délai: Post-intervention, Follow up (8 weeks)
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Serious adverse events will be based on participant or caregiver report, and confirmed with primary care physician as appropriate.
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Post-intervention, Follow up (8 weeks)
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Collaborateurs et enquêteurs
Parrainer
Collaborateurs
Les enquêteurs
- Chercheur principal: Vincent G DePaul, PhD (c), McMaster University, Hamilton, ON, Canada
Publications et liens utiles
Dates d'enregistrement des études
Dates principales de l'étude
Début de l'étude
Achèvement primaire (Réel)
Achèvement de l'étude (Réel)
Dates d'inscription aux études
Première soumission
Première soumission répondant aux critères de contrôle qualité
Première publication (Estimation)
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Estimation)
Dernière mise à jour soumise répondant aux critères de contrôle qualité
Dernière vérification
Plus d'information
Termes liés à cette étude
Termes MeSH pertinents supplémentaires
Autres numéros d'identification d'étude
- 06356
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