The study also discovered that patients steadily improved up to one year following the stroke, defying the conventional belief that recovery occurs early and tops out at six months. In fact, even patients who started physical therapy as late as six months after stroke were able to improve their walking.
The walking program involves having a patient walk on a treadmill in a harness that provides partial body weight support. This type of rehabilitation, known as locomotor training, has become progressively popular. After the patients complete their treadmill training, they practice walking.
The investigators of the Locomotor Experience Applied Post-Stroke (LEAPS) trial set out to compare the effectiveness of the body-weight supported treadmill training with walking practice beginning at two different stages—two months following stroke (early locomotor training) and six months post-stroke (late locomotor training). The locomotor training was also compared to an equivalent schedule of home exercise managed by a physical therapist, aimed at enhancing patients’ flexibility, range of motion, balance and strength as a way to improve walking. The main measurement was each group’s improvement in walking in one year following stroke.
At the end of one year, 52 percent of all the study participants had made large improvements in their walking ability. The timing of the locomotor training program seemed irrelevant. At one year, no differences were found in the proportion of patients who improved walking with the early or late treadmill training program, nor did the severity of their stroke affect their ability to make progress by the end of the year.
The patients’ measure of improvement was based on how well they were capable of walking independently by the end of the study. For example, stroke patients who were severely impaired were considered improved when they were able to walk around the inside of the house. Whereas patients who were had already achieved mobility at home were considered improved when they could progress to walking independently outside their home.
Researchers found that both the locomotor training and the home physical therapy were both superior to standard care. Following six months, the patients who were assigned to usual therapy recovered only about half as much as the participants who received one of the two study therapy program for three months. This finding suggests that either treadmill training or at-home balance and strength-training programs are effective forms of physical therapy and superior to standard care practices.
According to principal investigator, Pamela Duncan, Ph.D., “We were pleased to see that stroke patients who had a home physical therapy exercise program improved just as well as those who did the locomotor training. The home physical therapy program is more convenient and pragmatic. Usual care should incorporate more intensive exercise programs that are easily accessible to patients to improve walking, function and quality of life."