School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada.
BMC Neurol. 2011 Oct 21;11:129. doi: 10.1186/1471-2377-11-129.
Although task-oriented training has been shown to improve walking outcomes after stroke, it is not yet clear whether one task-oriented approach is superior to another. The purpose of this study is to compare the effectiveness of the Motor Learning Walking Program (MLWP), a varied overground walking task program consistent with key motor learning principles, to body-weight-supported treadmill training (BWSTT) in community-dwelling, ambulatory, adults within 1 year of stroke.
METHODS/DESIGN: A parallel, randomized controlled trial with stratification by baseline gait speed will be conducted. Allocation will be controlled by a central randomization service and participants will be allocated to the two active intervention groups (1:1) using a permuted block randomization process. Seventy participants will be assigned to one of two 15-session training programs. In MLWP, one physiotherapist will supervise practice of various overground walking tasks. Instructions, feedback, and guidance will be provided in a manner that facilitates self-evaluation and problem solving. In BWSTT, training will emphasize repetition of the normal gait cycle while supported over a treadmill, assisted by up to three physiotherapists. Outcomes will be assessed by a blinded assessor at baseline, post-intervention and at 2-month follow-up. The primary outcome will be post-intervention comfortable gait speed. Secondary outcomes include fast gait speed, walking endurance, balance self-efficacy, participation in community mobility, health-related quality of life, and goal attainment. Groups will be compared using analysis of covariance with baseline gait speed strata as the single covariate. Intention-to-treat analysis will be used.
In order to direct clinicians, patients, and other health decision-makers, there is a need for a head-to-head comparison of different approaches to active, task-related walking training after stroke. We hypothesize that outcomes will be optimized through the application of a task-related training program that is consistent with key motor learning principles related to practice, guidance and feedback.
ClinicalTrials.gov # NCT00561405.
虽然任务导向训练已被证明能改善中风后的步行效果，但目前尚不清楚一种任务导向方法是否优于另一种方法。本研究旨在比较运动学习步行计划（MLWP）与减重支持跑步机训练（BWSTT）在中风后 1 年内的社区居住、能行走的成年人中的有效性。
方法/设计：将进行一项平行、随机对照试验，并按基线步行速度进行分层。所有分配将由中央随机服务控制，参与者将通过随机分组随机分配到两个主动干预组（1:1）。70 名参与者将被分配到两个 15 节训练课程中的一个。在 MLWP 中，一名物理治疗师将监督各种地面行走任务的练习。将以促进自我评估和解决问题的方式提供指导、反馈和指导。在 BWSTT 中，训练将强调在跑步机上支持下重复正常的步态周期，由多达三名物理治疗师协助。将由盲法评估员在基线、干预后和 2 个月随访时评估结果。主要结果将是干预后的舒适步行速度。次要结果包括快速步行速度、步行耐力、平衡自我效能、社区移动性参与、健康相关生活质量和目标实现。将使用协方差分析比较各组，以基线步行速度分层为单一协变量。将采用意向治疗分析。
为了指导临床医生、患者和其他卫生决策者，需要对头对头比较中风后不同的主动、与任务相关的步行训练方法。我们假设通过应用与实践、指导和反馈相关的关键运动学习原则一致的与任务相关的训练计划，可以优化结果。
ClinicalTrials.gov # NCT00561405。
