In the largest stroke rehabilitation study ever conducted in the United States, stroke patients who had physical therapy at home improved their ability to walk just as well as those who were treated in a training program that requires the use of a body-weight supported treadmill device followed by walking practice.
The study, funded by the NIH, also found that patients continued to improve up to 1 year after stroke, defying conventional wisdom that recovery occurs early and tops out at 6 months. In fact, even patients who started rehabilitation as late as 6 months after stroke were able to improve their walking, according to a press release.
“More than 4 million stroke survivors experience difficulty walking. Rigorously comparing available physical therapy treatments is essential to determine which is best,” Walter Koroshetz, MD, NINDS deputy director, stated in the release. “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 investigators of the Locomotor Experience Applied Post-Stroke (LEAPS) trial set out to compare the effectiveness of the body-weight supported treadmill training with walking practice started at two different stages – 2 months post-stroke and 6 months post-stroke. The training was also compared against a home exercise program managed by a physical therapist.
The investigators had hypothesized that the body-weight supported treadmill and walking program, especially early locomotor training, would be superior to a home exercise program. However, they found that all groups did equally well, achieving similar gains in walking speed, motor recovery, balance, social participation and quality of life.
At the end of one year, 52% of all the study participants had made significant improvements in their ability to walk. The timing of the locomotor training program did not seem to matter. At 1 year, no differences were found in the proportion of patients who improved walking with the early or late treadmill training program, nor did the severity of their stroke affect their ability to make progress by the end of the year.
“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,” Pamela W. Duncan, PhD, principal investigator of LEAPS, and professor at Duke University School of Medicine in Durham, N.C., stated. “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.”