Treadmill training more effective than Bobath training in improving walking following stroke

Abstract

After recent stroke, does six weeks of aerobic treadmill training increase maximum walking speed and capacity more than Bobath walking training? Randomised, controlled trial with concealed allocation. Rehabilitation unit. Fifty patients were recruited within six weeks of their first supratentorial stroke. Eligibility criteria included ability to walk 12 m with intermittent help or stand-by, 50 to 75 years of age, a Barthel Index of 50 to 80, and participation in a 12-week rehabilitation program. Twenty-five patients were randomised to the treatment group and 25 to the control group. Each patient received 60 min of individual physiotherapy time per week day for six weeks. For patients in the treatment group, therapy consisted of 30 min of treadmill training and 30 min of Bobath walking training. During treadmill training, patients wore a harness to prevent falls and exercised at 60% of their heart rate reserve. Patients in the control group received 60 min of Bobath walking training. Other aspects of the rehabilitation programme were maintained in both groups according to individual needs. The primary outcomes were walking speed and capacity, measured at the end of the six week program and 12 weeks later. Speed was taken as the average of two trials of walking 10 m at maximum speed. Capacity was assessed using the six minute walk test. Secondary outcomes included gross motor functions and walking quality. From baseline to six weeks, speed increased 0.15 m/sec (95% CI 0.12 to 0.18) and capacity increased 34.9 m (95% CI 14.8 to 55) more in the treatment group than in the control group. From baseline to 12 weeks post-program, speed increased 0.22 m/sec (95% CI 0.12 to 0.32) and capacity increased 54.3 m (95% CI 29.8 to 78.2) more in the treatment group than in the control group. Secondary outcomes did not differ significantly at any time between groups. Treadmill training induces greater improvements in walking speed and distance than Bobath walking training in patients with moderate physical disability due to recent first stroke.