Low-tech physical therapy is just as effective as more expensive, specialized treadmill training to help patients improve their ability to walk following a stroke, a new study shows. The findings, published online today in the New England Journal of Medicine, also trump conventional wisdom that recovery peaks within 6 months after a stroke.
In the largest stroke rehabilitation study ever conducted in the United States, investigators studied 408 patients with moderate or severe walking difficulties. Patients were randomly assigned to 1 of 3 treatment plans: specialized treadmill training beginning either 2 months or 6 months after their stroke, or a home exercise program overseen by a physical therapist starting 2 months after their stroke.
The researchers examined an increasingly popular technique known as locomotor training, which includes a treadmill with a harness. Patients slip into the harness so their body weight is partially supported, and therapists help with their leg movements as they step on the treadmill.
In the home exercise program, patients worked with a therapist to improve their flexibility, joint movements, arm and leg strength, coordination, and balance.
Patients in all 3 groups had 36 treatment sessions over a 12- to 16-week period. Investigators evaluated all patients 1 year after their stroke and found that 52% had significant improvements. They could walk faster and farther, and their balance improved after treatment.
Regardless of impairment level or when treatment began, the degree of improvement was similar among the 3 treatment groups. The rate of falls was similar among all groups, but patients in the exercise group were less likely to feel dizzy or faint during treatment.
Compared with treadmill rehabilitation, home exercise is less expensive, therapists need less training, and patients are more likely to adhere to the program, the researchers said. “Our results suggest that home exercise is a more pragmatic form of therapy with fewer risks,” they wrote.