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Abstract
Mudge S, Barber PA, Stott NS. Circuit-based rehabilitation improves gait endurance
but not usual walking activity in chronic stroke: a randomized controlled trial.
To determine whether circuit-based rehabilitation would increase the amount and rate
that individuals with stroke walk in their usual environments.
Single-blind randomized controlled trial.
Rehabilitation clinic.
Sixty participants with a residual gait deficit at least 6 months after stroke originally
enrolled in the study. Two withdrew in the initial phase, leaving 58 participants
(median age, 71.5y; range, 39.0-89.0y) who were randomized to the 2 intervention groups.
The exercise group had 12 sessions of clinic-based rehabilitation delivered in a circuit
class designed to improve walking. The control group received a comparable duration
of group social and educational classes.
Usual walking performance was assessed using the StepWatch Activity Monitor. Clinical
tests were gait speed (timed 10-meter walk) and endurance (six-minute walk test [6MWT]),
confidence (Activities-Based Confidence Scale), self-reported mobility (Rivermead
Mobility Index [RMI]), and self-reported physical activity (Physical Activity and
Disability Scale).
Intention-to-treat analysis revealed that the exercise group showed a significantly
greater distance for the 6MWT than the control group immediately after the intervention
(P=.030) but that this effect was not retained 3 months later. There were no changes
in the StepWatch measures of usual walking performance for either group. The exercise
and control groups had significantly different gait speed (P=.038) and scores on the
RMI (P=.025) at the 3-month follow-up. These differences represented a greater decline
in the control group compared with the exercise group for both outcome measures.
Circuit-based rehabilitation leads to improvements in gait endurance but does not
change the amount or rate of walking performance in usual environments. Clinical gains
made by the exercise group were lost 3 months later. Future studies should consider
whether rehabilitation needs to occur in usual environments to improve walking performance.