Article

OBJECTIVE: To determine whether circuit-based rehabilitation
would increase the amount and rate that individuals with stroke walk in their
usual environments. DESIGN: Single-blind randomized controlled trial. SETTING:
Rehabilitation clinic. PARTICIPANTS: 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. INTERVENTIONS: 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. MAIN OUTCOME
MEASURES: 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). RESULTS:
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. CONCLUSIONS:
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.

Langue : ANGLAIS