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Combining fast walking training and a step activity monitoring program to improve daily walking activity after stroke: a preliminary study
Danks KA, Pohlig R, Reisman DS
Archives of Physical Medicine and Rehabilitation 2016 Sep;97(Suppl 9):S185-S193
clinical trial
4/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: No; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: No; 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*

OBJECTIVE: To determine preliminary efficacy and to identify baseline characteristics predicting who would benefit most from fast walking training plus a step activity monitoring program (FAST+SAM) compared to fast walking training alone (FAST) in persons with chronic stroke. DESIGN: Randomized controlled trial with blinded assessors SETTING: Outpatient clinical research laboratory PARTICIPANTS: 37 individuals greater than 6 months post-stroke. INTERVENTIONS: Subjects were assigned to either FAST which was walking training at their fastest possible speed on the treadmill (30 minutes) and over ground 3 times/week for 12 weeks or FAST plus a step activity monitoring program (FAST+SAM). The step activity monitoring program consisted of daily step monitoring with a StepWatch Activity monitor, goal setting, and identification of barriers to activity and strategies to overcome barriers. MAIN OUTCOME MEASURES: Daily step activity metrics (steps/day, time walking/day), walking speed and six minute walk test distance (6MWT). RESULTS: There was a significant effect of time for both groups with all outcomes improving from pre to post-training (all p < 0.05). The FAST+SAM was superior to FAST for 6MWT (p = 0.018), with a larger increase in the FAST+SAM group. The interventions had differential effectiveness based on baseline step activity. Sequential moderated regression models demonstrated that for subjects with baseline levels of step activity and 6MWT distances that were below the mean, the FAST+SAM intervention was more effective than FAST (1,715 +/- 1,584 versus 254 +/- 933 steps/day, respectively; p < 0.05 for overall model and deltaR2 for steps/day and 6MWT). CONCLUSIONS: The addition of a step activity monitoring program to a fast walking training intervention may be most effective in persons with chronic stroke that have initial low levels of walking endurance and activity. Regardless of baseline performance, the FAST+SAM intervention was more effective for improving walking endurance.

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