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Circuit-based rehabilitation improves gait endurance but not usual walking activity in chronic stroke: a randomized controlled trial
Mudge S, Barber PA, Stott NS
Archives of Physical Medicine and Rehabilitation 2009 Dec;90(12):1989-1996
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: No; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

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 to 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 = 0.030) 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 = 0.038) and scores on the RMI (p = 0.025) 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.

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