Treadmill training provides greater benefit to the subgroup of community-dwelling people after stroke who walk faster than 0.4m/s: a randomised trial

Abstract

Question: After stroke, does treadmill training provide greater benefit to the subgroup of community-dwelling people who walk faster than 0.4m/s than those who walk more slowly?

Design: Subgroup analysis of a randomised trial: the AMBULATE trial.

Participants: 68 people with stroke living in the community.

Intervention: The experimental group received 30 minutes of treadmill and overground walking, three times a week for four months; the control group received no intervention.

Outcome measures: The primary outcome was walking distance covered during the six-minute walk test. Other outcomes were comfortable and fast walking speed and health status.

Results: At four months, in the subgroup of participants with a baseline comfortable walking speed of > 0.4m/s, treadmill training produced an extra distance of 72m (95% CI 23 to 121) and an increased comfortable speed of 0.16m/s (95% CI 0.00 to 0.32), compared with the subgroup with a speed of ≤0.4m/s. There was also a trend towards an extra fast speed of 0.17m/s (95% CI -0.04 to 0.36). There was no extra effect of treadmill training in the faster walkers in terms of EuroQol 5Q-5D. There were no differences between the experimental and control groups between subgroups in the long term.

Conclusion: Treadmill training is more likely to benefit people who walk at a speed of > 0.4m/s. Clinicians should use comfortable walking speed to predict the potential for improvement and to guide intervention.

Trial registration: ACTRN12607000227493.

Keywords: Cerebrovascular accident; Community participation; Randomised controlled trial; Rehabilitation; Stroke.