Effects of Task-Specific Locomotor and Strength Training in Adults Who Were Ambulatory After Stroke: Results of the STEPS Randomized Clinical Trial.

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Presentation transcript:

Effects of Task-Specific Locomotor and Strength Training in Adults Who Were Ambulatory After Stroke: Results of the STEPS Randomized Clinical Trial

Background and Purpose

  A phase II, single-blinded, randomized clinical trial was conducted to determine the effects of combined task-specific and lower-extremity (LE) strength training to improve walking ability after stroke.

Subjects

  The participants were 80 adults who were ambulatory 4 months to 5 years after a unilateral stroke.

Method

Eligibility criteria   age 18 years or older   4 months to 5 years after first-time onset of a ischemic or hemorrhagic CVA   able to ambulate at least 14m with an assistive or orthotic device assistance of one person   voluntarily provided informed consent   approval of their primary care physician to participate

Exclusion criteria   Health conditions   recent exercise study participation   Serious medical conditions

  Exercise sessions were 4 times per week for 6 weeks   Outcomes were self-selected walking speed, fast walking speed, and 6-minute walk distance measured before and after intervention and at a 6-month follow-up.

BWSTT ： body-weight-supported treadmill training CYCLE ： limb-loaded resistive leg cycling BWSTT ： body-weight-supported treadmill training CYCLE ： limb-loaded resistive leg cycling LE-EX ： LE muscle-specific progressive-resistive exercise UE-EX ： upper-extremity ergometry LE-EX ： LE muscle-specific progressive-resistive exercise UE-EX ： upper-extremity ergometry   BWSTT / UE-EX   CYCLE / UE-EX   BWSTT / CYCLE   BWSTT / LE-EX

Strcjke severity BWSTT ＆ UE-EX CYCLE ＆ UE-EX BWSTT ＆ CYCLE BWSTT ＆ LE-EX LE-FM motor score (maximum score=34) 24.5 (5.5) 24.4 (4.5) 24.2 (4.0) 22.1 (6.3) Berg Balance Scale (maximum score=56) 42.1 (9.8) 42.6 (11.4) 45.2 (10.1) 40.4 (15.0)

Primary and outcomes at baseline BWSTT ＆ UE-EX CYCLE ＆ UE-EX BWSTT ＆ CYCLE BWSTT ＆ LE-EX Comfortable gait speed (m/s) 0.49 (0.24) 0.48 (0.28) 0.53 (0.28) 0.52 (0.35) Fast gait speed (m/s) 0.69 (0.38) 0.65 (0.42) 0.71 (0.38) 0.76 (0.50) 6-min walk distance (m) (99.9) (115.2) (99.9) (135.4)

After 24 Treatment Sessions

BWSTT ＆ UE-EX CYCLE ＆ UE-EX BWSTT ＆ CYCLE BWSTT ＆ LE-EX Baseline 0.50 (0.23) 0.43 (0.25) 0.54 (0.28) 0.57 (0.35) Pusiintervention 0.63 (0.32) 0.44 (0.26) 0.63 (0.33) 0.67 (0.37) Change 0.13 (0.14) 0.01 (0.07) 0.09 (0.12) 0.10 (0.07) 10-m Comfortable gait speed(m/s)

10-m fast gait speed (m/s) BWSTT ＆ UE-EX CYCLE ＆ UE-EX BWSTT ＆ CYCLE BWSTT ＆ LE-EX Baseline 0.71 (0.37) 0.57 (0.36) 0.73 (0.39) 0.80 (0.51) Pusiintervention 0.81 (0.43) 0.58 (0.39) 0.81 (0.44) 0.90 (0.51) Change 0.10 (0.14) 0.01 (0.09) 0.08 (0.13) 0.10 (0.08)

6-min walk distance (m) BWSTT ＆ UE-EX CYCLE ＆ UE-EX BWSTT ＆ CYCLE BWSTT ＆ LE-EX Baseline (96.4) (99.6) (102.3) (137.87) Pusiintervention (106.0) (118.6) (122.6) (144.57) Change 22.5 (34.8) 15.5 (31.0) 25.5 (37.6) 45.3 (33.5)

6-Month Follow-up

BWSTT ＆ UE-EX CYCLE ＆ UE-EX BWSTT ＆ CYCLE BWSTT ＆ LE-EX Post-session (0.32) 0.44 (0.26) 0.63 (0.33) 0.67 (0.37) 6-mo foliow-up 0.65 (0.33) 0.43 (0.26) 0.64 (0.32) 0.77 (0.03) Change 0.02 (0.11) (0.11) 0.01 (0.10) 0.05 (0.09) 10-m Comfortable gait speed(m/s)

10-m fast gait speed (m/s) BWSTT ＆ UE-EX CYCLE ＆ UE-EX BWSTT ＆ CYCLE BWSTT ＆ LE-EX Post-session (0.43) 0.58 (0.39) 0.81 (0.44) 0.90 (0.51) 6-mo foliow-up 0.82 (0.44) 0.60 (0.42) 0.83 (0.43) 0.94 (0.69) Change 0.01 (0.10) (0.17) 0.02 (0.12) (0.37)

6-min walk distance (m) BWSTT ＆ UE-EX CYCLE ＆ UE-EX BWSTT ＆ CYCLE BWSTT ＆ LE-EX Post-session (106.0) (118.6) (122.6) (144.57) 6-mo foliow-up (116.85) (116.13) (131.31) (133.03) Change 0.04 (55.54) (55.40) (24.70) 0.71 (32.64)

Results

Discussion and Conclusion

BWSTT/UE-EX V.S CYCLE/UE-EX

BWSTT ＆ UE-EX CYCLE ＆ UE-EX BWSTT ＆ CYCLE BWSTT ＆ LE-EX Post-session (0.32) 0.44 (0.26) 0.63 (0.33) 0.67 (0.37) 6-mo foliow-up 0.65 (0.33) 0.43 (0.26) 0.64 (0.32) 0.77 (0.03) Change 0.02 (0.11) (0.11) 0.01 (0.10) 0.05 (0.09) 10-m Comfortable gait speed(m/s)

10-m fast gait speed (m/s) BWSTT ＆ UE-EX CYCLE ＆ UE-EX BWSTT ＆ CYCLE BWSTT ＆ LE-EX Post-session (0.43) 0.58 (0.39) 0.81 (0.44) 0.90 (0.51) 6-mo foliow-up 0.82 (0.44) 0.60 (0.42) 0.83 (0.43) 0.94 (0.69) Change 0.01 (0.10) (0.17) 0.02 (0.12) (0.37)

6-min walk distance (m) BWSTT ＆ UE-EX CYCLE ＆ UE-EX BWSTT ＆ CYCLE BWSTT ＆ LE-EX Post-session (106.0) (118.6) (122.6) (144.57) 6-mo foliow-up (116.85) (116.13) (131.31) (133.03) Change 0.04 (55.54) (55.40) (24.70) 0.71 (32.64)