Gains in Daily Stepping Activity in People With Chronic Stroke After High-Intensity Gait Training in Variable Contexts.
Study Goal
The researchers aimed to determine the influence of different walking interventions on daily stepping (steps per day) and the contributions of demographic, training, and clinical measures to these changes in individuals with chronic stroke.
Results Summary
Gains in steps per day were observed across all groups, with significant gains only following high-intensity training (HIT) in variable contexts. Both HIT groups showed gains in endurance (6MWT), with increases in balance confidence only following HIT in variable contexts, and changes in steps per day were primarily associated with gains in 6MWT.
Population
Individuals who were ambulatory and >6 months after stroke.
Effective Dosage
≤30 sessions of high-intensity training (HIT) in variable contexts, HIT focused on forward walking, or low-intensity variable training.
Duration
Not explicitly stated, but outcomes were measured post-training and at a 3-month follow-up.
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
high-intensity training (HIT) in variable contexts | increase | daily stepping | individuals who were ambulatory and >6 months after stroke | - | elicited gains | #1 |
high-intensity training (HIT) in variable contexts | increase | steps per day | individuals who were ambulatory and >6 months after stroke | - | revealed significant gains | #2 |
high-intensity training (HIT) in variable contexts | increase | balance confidence | individuals who were ambulatory and >6 months after stroke | - | increases | #3 |
high-intensity training (HIT) in variable contexts | increase | measures of participation (eg, daily stepping) | individuals who were ambulatory and >6 months after stroke | - | improve | #4 |
high-intensity training (HIT) in variable contexts | increase | physical therapy services | - | - | improve the efficiency and value | #5 |
high-intensity training (HIT) focused on forward walking | increase | endurance (6MWT) | individuals who were ambulatory and >6 months after stroke | - | showed gains | #6 |
high-intensity training (HIT) in variable contexts | increase | endurance (6MWT) | individuals who were ambulatory and >6 months after stroke | - | showed gains | #7 |
low-intensity variable training | no change | steps per day | individuals who were ambulatory and >6 months after stroke | - | - | #8 |
high-intensity training (HIT) focused on forward walking | no change | steps per day | individuals who were ambulatory and >6 months after stroke | - | - | #9 |
low-intensity variable training | no change | balance confidence | individuals who were ambulatory and >6 months after stroke | - | - | #10 |
high-intensity training (HIT) focused on forward walking | no change | balance confidence | individuals who were ambulatory and >6 months after stroke | - | - | #11 |
OBJECTIVE: Many physical therapist interventions provided to individuals with chronic stroke can lead to gains in gait speed or endurance (eg, 6-Minute Walk Test [6MWT]), although changes in objective measures of participation are not often observed. The goal of this study was to determine the influence of different walking interventions on daily stepping (steps per day) and the contributions of demographic, training, and clinical measures to these changes. METHODS: In this secondary analysis of a randomized clinical trial, steps per day at baseline and changes in steps per day following 1 of 3 locomotor interventions were evaluated in individuals who were ambulatory and >6 months after stroke. Data were collected on 58 individuals who received ≤30 sessions of high-intensity training (HIT) in variable contexts (eg, tasks and environments; n = 19), HIT focused on forward walking (n = 19), or low-intensity variable training (n = 20). Primary outcomes were steps per day at baseline, at post-training, and at a 3-month follow-up, and secondary outcomes were gait speed, 6MWT, balance, and balance confidence. Correlation and regression analyses identified demographic and clinical variables associated with steps per day. RESULTS: Gains in steps per day were observed across all groups combined, with no between-group differences; post hoc within-group analyses revealed significant gains only following HIT in variable contexts. Both HIT groups showed gains in endurance (6MWT), with increases in balance confidence only following HIT in variable contexts. Changes in steps per day were associated primarily with gains in 6MWT, with additional associations with baseline 6MWT, lower-extremity Fugl-Meyer scores, and changes in balance confidence. CONCLUSION: HIT in variable contexts elicited gains in daily stepping, with changes primarily associated with gains in gait endurance. IMPACT: Providing HIT in variable contexts appears to improve measures of participation (eg, daily stepping) that may be associated with clinical measures of function. Gains in multiple measures of mobility and participation with HIT in variable contexts may improve the efficiency and value of physical therapy services.