Published online before print September 17, 2009, doi: 10.1161/STROKEAHA.109.558940
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Stroke. 2009;40:e627.)
© 2009 American Heart Association, Inc.
Cochrane Corner |
Overground Physical Therapy Gait Training for Chronic Stroke Patients With Mobility Deficits
From the Department of Physical Therapy, Long Island University, Brooklyn, NY.
Correspondence to Dr Rebecca States, Long Island University, Division of Physical Therapy, 1 University Plaza, HS 213, Brooklyn, NY 11201. E-mail rstates{at}liu.edu
Graeme J. Hankey MD, FRCP Section Editor:
 |
Abstract |
|---|
 Top Abstract IntroductionMethodsResultsConclusionsReferences |
|---|
Background and Purpose— Overground gait training can be defined as a physical therapists’ observation and cueing of the patient’s walking pattern along with related exercises, but does not include high-technology aids such as functional electric stimulation or body weight support. This systematic review investigated the effects of overground physical therapy gait training on walking ability for chronic stroke patients with mobility deficits.
Methods— A comprehensive literature search was performed as per the Cochrane group guidelines. Only randomized controlled trials that compared overground physical therapy gait training to a placebo intervention or no treatment for chronic stroke patients with mobility deficits were included.
Results— Nine studies involving 499 participants matched the inclusion criteria and had moderate methodological quality. Results were mixed with no significant effect on the primary variable, gait function. Small effects for several performance variables were found: gait speed increased by 0.07 meters per second (95% confidence interval [CI]=0.05 to 0.10) based on 7 studies with 396 participants, timed up-and-go (TUG) test improved by 1.81 seconds (95% CI=–2.29 to –1.33) based on 3 studies and 118 participants, and 6-minute-walk test (6MWT) increased by 26.06 meters (95% CI=7.14 to 44.97) based on 4 studies with 181 participants. No significant differences in adverse events were found.
Conclusions— There is insufficient evidence to determine whether overground gait training directly benefits broad measures of gait function. Results from recent studies, however, suggest that specific training protocols may provide limited benefits for more uni-dimensional performance variables like gait speed, TUG test, and 6MWT.
Key Words: functional recovery • physiotherapy • stroke recovery • gait
|
Introduction |
|---|
|
TopAbstractIntroductionMethodsResultsConclusionsReferences |
|---|
Gait training forms a major component of physical therapy services for chronic stroke patients and is the most common intervention provided to stroke patients in general.1 Overground gait training can be defined as a physical therapists’ observation and cueing of the patient’s walking pattern along with related exercises, but does not include high-technology aids such as functional electric stimulation or body weight support. The purpose of this systematic review was to investigate the effects of overground physical therapy gait training on walking ability for chronic stroke patients with mobility deficits.2
|
Methods |
|---|
|
TopAbstractIntroductionMethodsResultsConclusionsReferences |
|---|
A comprehensive literature search was performed as per the Cochrane group guidelines. Only randomized controlled trials that compared overground physical therapy gait training to a placebo intervention or no treatment for chronic stroke patients with mobility deficits were included. Pairs of authors independently selected trials. Three authors independently extracted data and assessed quality.
|
Results |
|---|
|
TopAbstractIntroductionMethodsResultsConclusionsReferences |
|---|
From the 3793 citations generated by the search, we found 9 studies involving 499 participants that matched the inclusion criteria. The methodological quality of the studies was moderate (6 to 9 in the PEDRO scale). Results were mixed with no significant effect on the primary variable, gait function. In contrast, small effects for several uni-dimensional performance variables were found: gait speed increased by 0.07 meters per second as shown in the Figure (95% confidence interval [CI]=0.05 to 0.10) based on 7 studies with 396 participants, timed up-and-go (TUG) test improved by 1.81 seconds (95% CI=–2.29 to –1.33) based on 3 studies and 118 participants, and 6-minute-walk test (6MWT) increased by 26.06 meters (95% CI=7.14 to 44.97) based on 4 studies with 181 participants. We found no significant differences across conditions in deaths/disabilities or in adverse effects. Few adverse events were reported.
|
|
Conclusions |
|---|
|
TopAbstractIntroductionMethodsResultsConclusionsReferences |
|---|
Implications for Practice
There is insufficient evidence to determine whether overground gait training directly benefits broad measures of gait function. Results from recent studies, however, suggest that specific training protocols may provide limited benefits for more uni-dimensional performance variables like gait speed, TUG test, and 6MWT.3–8
Implications for Research
Considering the high frequency with which gait training is used in the treatment of patients with chronic stroke and that two thirds of stroke survivors have difficulty with walking, there is a clear need for larger well-designed randomized controlled studies examining the effectiveness of overground physical therapy gait training for chronic stroke patients with mobility deficits. New research should also examine the reasons overground gait training is used so frequently at each stage of stroke rehabilitation. One hypothesis is that overground gait training acts primarily as an adjunctive therapy, educating patients about ways to maintain safety as they engage in more challenging therapeutic approaches designed to increase strength and cardiovascular fitness, alter coordination or quality of gait, or improve agility and gait efficiency.
Note: This article is based on a Cochrane Review published in The Cochrane Library 2009, Issue 3 (see www.thecochranelibrary.com, for information). Cochrane reviews are regularly updated as new evidence emerges and in response to feedback, and The Cochrane Library should be consulted for the most recent version of the review.
|
Acknowledgments |
|---|
Sources of Funding
This work was supported by a Long Island University Sabbatical Award for Rebecca States, 2005.
Disclosures
None.
Received May 28, 2009; accepted June 9, 2009.
|
References |
|---|
|
TopAbstractIntroductionMethodsResultsConclusionsReferences |
|---|
1. Jette DU, Latham NK, Smout RJ, Gassaway J, Slavin MD, Horn SD. Physical therapy interventions for patients with stroke in inpatient rehabilitation facilities. Phys Ther. 2005; 85: 238–248.
2. States RA, Pappas E, Salem Y. Overground physical therapy gait training for people with chronic stroke with mobility deficits. The Cochrane Database of Syst Rev. 2009 (3); Art. No.: CD006075.
3. Dean CM, Richards CL, Malouin F. Task-related circuit training improves performance of locomotor tasks in chronic stroke: a randomized, controlled pilot trial. Arch Phys Med Rehabil. 2000; 81: 409–417.[CrossRef][Medline] [Order article via Infotrieve]
4. Pang MY, Eng JJ, Dawson AS, McKay HA, Harris JE. A community-based fitness and mobility exercise program for older adults with chronic stroke: a randomized, controlled trial. JAGS. 2005; 53: 1667–1674.
5. Salbach NM, Mayo NE, Wood-Dauphinee S, Hanley JA, Richards CL, Cote R. A task-orientated intervention enhances walking distance and speed in the first year post stroke: a randomized controlled trial. Clin Rehabil. 2004; 18: 509–519.
6. Yang Y, Wang R, Lin K, Chu M, Chan R. Task-oriented progressive resistance strength training improves muscle strength and functional performance in individuals with stroke. Clin Rehabil. 2006; 20: 860–870.
7. Yang YR, Wang RY, Chen YC, Kao MJ. Dual-task exercise improves walking ability in chronic stroke: a randomized controlled trial. Arch Phys Med Rehabil. 2007; 88: 1236–1240.[CrossRef][Medline] [Order article via Infotrieve]
8. Wall JC, Turnbull GI. Evaluation of out-patient physiotherapy and a home exercise program in the management of gait asymmetry in residual stroke. J Neurol Rehabil. 1987; 3: 115–123.
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||