What kind of therapy works best for stroke patients?
According to a new study, an intensive home-exercise program that emphasizes flexibility, strength and balance was just as effective as high-tech treadmills.
In the largest stroke rehabilitation study ever conducted in the United States, researchers found that stroke patients regain walking ability through at-home strength and balance exercise provided by a physical therapist — and that method worked just as well as when they participated in programs that practice the actual task of walking, by using a treadmill and partial body weight support.
"For individuals who have suffered a stroke, the findings of this trial offer good news for improving walking within the first year post-stroke through intense physical therapy interventions," said Andrea Behrman, co-principal investigator and an associate professor in the department of physical therapy at the University of Florida College of Public Health and Health Professions.
The Locomotor Experience Applied Post-Stroke, or LEAPS, trial included more than 400 patients who were randomly assigned to a treadmill training group two or six months after their stroke or to a home-based therapy program. Primary funding for the study came from the National Institute of Neurological Disorders and Stroke.
Patients in the walking training group practiced walking in a clinic, using a treadmill with a device that provides partial body-weight support, also known as locomotor training. The home-based exercise therapy program was supervised by a physical therapist and focused on flexibility, range of motion, strength and balance.
At the one-year mark, 52 percent of all the study participants had made significant improvements in their walking ability. Both the walking training and exercise program patients had similar improvements in walking speed, motor recovery, balance, social participation and quality of life.
But the home-based exercise program may save on health-care costs and promote treatment adherence: Only 3 percent of patients in the home-based therapy dropped out of the study while 13 percent discontinued the locomotor training.
"The home physical therapy program is more convenient and pragmatic," said Pamela W. Duncan, the study's principal investigator and a professor at Duke University School of Medicine. "Usual care should incorporate more intensive exercise programs that are easily accessible to patients to improve walking, function and quality of life."
The research team found that patients in the group who began the therapy six months after their stroke also improved their walking. This finding challenges the widely held belief that patients can only make gains in their rehabilitation within the first few months of a stroke, the researchers say.
"More than 4 million stroke survivors experience difficulty walking. Rigorously comparing available physical therapy treatments is essential to determine which is best,'' said Dr. Walter Koroshetz, deputy director of National Institute of Neurological Disorders and Stroke. "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."
UF researchers on the team included Samuel Wu, an associate professor in the department of biostatistics; Dr. Stephen Nadeau, a professor in the departments of neurology and clinical and health psychology; and Dorian Rose, a research assistant professor in the department of physical therapy. Nadeau and Rose also hold appointments at the Malcom Randall Veterans Affairs Medical Center in Gainesville.
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