Catherine M Dean1, Louise Ada2, Richard I Lindley3. 1. Department of Health Professions, Macquarie University. 2. Discipline of Physiotherapy, The University of Sydney. 3. Discipline of Medicine, Westmead Clinical School, The University of Sydney, Australia.
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.
RCT Entities:
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.
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