ISC: Home-based therapy equal to treadmill training for stroke patients
Home-based physical therapy can improve the strength and balance of stroke survivors as well as treadmill training done in a physical therapy lab, according to the results of the LEAPS trial presented Feb. 11 at the American Stroke Association’s International Stroke Conference in Los Angeles.
"Until now, there has not been a major phase III trial to systematically evaluate different interventions,” said Pamela Woods Duncan, PhD, professor in the physical therapy division at Duke University and principal investigator of the National Institute of Health-funded LEAPS (Locomotor Experience Applied Post-Stroke) study, during the presentation. The LEAPS trial focused on assessing effective interventions for walking recovery of stroke patients.
The trial included 408 stroke survivors from six inpatient rehabilitation facilities within the states of California and Florida. The researchers randomized patients to receive locomotor training at two months or six months after a stroke or home exercise for 1.5 hours, three times a week for 12 weeks.
Locomotor-style training has become more prevalent in practice today and works by body-weight supported treadmill training where patients are suspended over a treadmill in a harness and walk with the help of physical therapists.
The home exercise program was conducted within a patient’s home with the assistance of a physical therapist and patients in the locomotor-style training group were assisted by two or three physical therapists.
The researchers evaluated patients’ improvement in walking one-year post-stroke.
The results showed that high-tech therapy may not be superior to home strength and balance training. In fact, in both groups, patients showed a 52 percent overall improvement, despite the type of therapy. "This is important, because the home-based intervention is more accessible, more feasible and it was also associated with fewer risks in our study," said Duncan.
Both groups did equally as well in terms of walking speed, motor recovery, balance, social participation and quality of life.
At six months, both interventions proved to be more effective than the physical therapy patients received two months post-stroke. "At six months, the improvement from either one of these interventions is twice what you see when patients get usual care," said Duncan.
However, Duncan did report that when locomotor training was integrated early after stroke, patients were at a higher risk for injurious falls.
"This suggests that as we move forward in clinical practice with programs to improve mobility, we also have to partner with more aggressive falls prevention strategies," Duncan said. "These programs need to improve balance and mobility, but also include risk assessment and management for falls prevention. For example, we should assess the patients' environment, their vision and their medications."
"Until now, there has not been a major phase III trial to systematically evaluate different interventions,” said Pamela Woods Duncan, PhD, professor in the physical therapy division at Duke University and principal investigator of the National Institute of Health-funded LEAPS (Locomotor Experience Applied Post-Stroke) study, during the presentation. The LEAPS trial focused on assessing effective interventions for walking recovery of stroke patients.
The trial included 408 stroke survivors from six inpatient rehabilitation facilities within the states of California and Florida. The researchers randomized patients to receive locomotor training at two months or six months after a stroke or home exercise for 1.5 hours, three times a week for 12 weeks.
Locomotor-style training has become more prevalent in practice today and works by body-weight supported treadmill training where patients are suspended over a treadmill in a harness and walk with the help of physical therapists.
The home exercise program was conducted within a patient’s home with the assistance of a physical therapist and patients in the locomotor-style training group were assisted by two or three physical therapists.
The researchers evaluated patients’ improvement in walking one-year post-stroke.
The results showed that high-tech therapy may not be superior to home strength and balance training. In fact, in both groups, patients showed a 52 percent overall improvement, despite the type of therapy. "This is important, because the home-based intervention is more accessible, more feasible and it was also associated with fewer risks in our study," said Duncan.
Both groups did equally as well in terms of walking speed, motor recovery, balance, social participation and quality of life.
At six months, both interventions proved to be more effective than the physical therapy patients received two months post-stroke. "At six months, the improvement from either one of these interventions is twice what you see when patients get usual care," said Duncan.
However, Duncan did report that when locomotor training was integrated early after stroke, patients were at a higher risk for injurious falls.
"This suggests that as we move forward in clinical practice with programs to improve mobility, we also have to partner with more aggressive falls prevention strategies," Duncan said. "These programs need to improve balance and mobility, but also include risk assessment and management for falls prevention. For example, we should assess the patients' environment, their vision and their medications."