Department of Neuropsychology and Neurorehabilitation, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Clin Rehabil. 2013 Oct;27(10):932-8. doi: 10.1177/0269215513485592. Epub 2013 Jun 24.
To assess whether a downhill walking training programme is more effective than the same amount of training applied uphill in chronic stroke survivors.
Randomized, single-blind study.
Outpatient rehabilitation service.
Thirty-eight adults with hemiplegia from stroke lasting more than three months were randomly allocated to one of the two groups: 'UP' - 45 minutes of physical therapy + 30 minutes of treadmill with 5% ascending slope; and 'DOWN' - 45 minutes of physical therapy + 30 minutes of treadmill with 5% descending slope. Both groups were treated 5 times a week for six weeks. Patients were evaluated before treatment, at the end of treatment and after three months.
Primary outcome measure was the number of patients showing an improvement in 6-minute walking test (6MWT) greater than 50 m. Secondary outcome measures were: (1) number of patients showing a clinically relevant improvement of gait speed during 10-m walking test (10mWT); (2) number of patients showing an improvement in timed up and go (TUG) greater than minimal detectable change.
Both groups had a significant improvement after treatment and at follow-up. At the end of treatment, compared to UP group, more patients in the DOWN group showed clinically significant improvements in primary and secondary outcomes (16/19 patients for 6MWT, 11/19 patients for 10mWT and 9/19 patients for TUG compared with 3/19, 4/19 and 2/19 patients, respectively, P < 0.01). At follow-up, results were similar except for 10mWT.
In chronic stroke patients, downhill treadmill training produces a bigger effect than uphill training.
评估下坡行走训练方案是否比在慢性中风幸存者中应用相同量的上坡训练更有效。
随机、单盲研究。
门诊康复服务。
将 38 名患有中风后超过三个月的偏瘫的成年人随机分配到两组之一：“UP” - 45 分钟物理治疗 + 30 分钟带有 5%上坡坡度的跑步机；和“DOWN” - 45 分钟物理治疗 + 30 分钟带有 5%下坡坡度的跑步机。两组均每周治疗 5 次，持续 6 周。患者在治疗前、治疗结束时和治疗后 3 个月进行评估。
主要结果测量指标是在 6 分钟步行测试（6MWT）中显示改善超过 50m 的患者人数。次要结果测量指标为：（1）在 10 米步行测试（10mWT）中显示步态速度有临床相关改善的患者人数；（2）在 TUG 中显示改善超过最小可检测变化的患者人数。
两组在治疗后和随访时均有显著改善。在治疗结束时，与 UP 组相比，DOWN 组有更多的患者在主要和次要结局中显示出临床显著的改善（16/19 例患者在 6MWT 中，11/19 例患者在 10mWT 中，9/19 例患者在 TUG 中，而 UP 组分别为 3/19、4/19 和 2/19 例患者，P<0.01）。在随访时，结果除了 10mWT 外，相似。
在慢性中风患者中，下坡跑步机训练比上坡训练产生更大的效果。
