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Influence of a locomotor training approach on walking speed and distance in people with chronic spinal cord injury: a randomized clinical trial [with consumer summary]
Field-Fote EC, Roach KE
Physical Therapy 2011 Jan;91(1):48-60
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Impaired walking limits function after spinal cord injury (SCI), but training-related improvements are possible even in people with chronic motor incomplete SCI. OBJECTIVE: The objective of this study was to compare changes in walking speed and distance associated with 4 locomotor training approaches. DESIGN: This study was a single-blind, randomized clinical trial. SETTING: This study was conducted in a rehabilitation research laboratory. PARTICIPANTS: Participants were people with minimal walking function due to chronic SCI. INTERVENTION: Participants (n = 74) trained 5 days per week for 12 weeks with the following approaches: treadmill-based training with manual assistance (TM), treadmill-based training with stimulation (TS), overground training with stimulation (OG), and treadmill-based training with robotic assistance (LR). MEASUREMENTS: Overground walking speed and distance were the primary outcome measures. RESULTS: In participants who completed the training (n = 64), there were overall effects for speed (effect size index (d) = 0.33) and distance (d = 0.35). For speed, there were no significant between-group differences; however, distance gains were greatest with OG. Effect sizes for speed and distance were largest with OG (d = 0.43 and d = 0.40, respectively). Effect sizes for speed were the same for TM and TS (d = 0.28); there was no effect for LR. The effect size for distance was greater with TS (d = 0.16) than with TM or LR, for which there was no effect. Ten participants who improved with training were retested at least 6 months after training; walking speed at this time was slower than that at the conclusion of training but remained faster than before training. LIMITATIONS: It is unknown whether the training dosage and the emphasis on training speed were optimal. Robotic training that requires active participation would likely yield different results. CONCLUSIONS: In people with chronic motor incomplete SCI, walking speed improved with both overground training and treadmill-based training; however, walking distance improved to a greater extent with overground training.

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