How feasible is the attainment of community ambulation after stroke? A pilot randomized controlled trial to evaluate community-based physiotherapy in subacute stroke

Lord, Susan
McPherson, Kathryn M
McNaughton, Harry K
Rochester, Lynn
Weatherall, Mark

Susan Lord Department of Medicine (Rehabilitation), Wellington School of Medicine and Health Sciences, University of Otago Kathryn M McPherson Division of Rehabilitation and Occupation Studies, Auckland University of Technology Harry K McNaughton Medical Research Institute of New Zealand, Wellington, New Zealand Lynn Rochester Gerontology Research Programme, HealthQWest, Glasgow, UK Mark Weatherall Department of Medicine (Rehabilitation), Wellington School of Medicine and Health Sciences, University of Otago, New Zealand

Address for correspondence: Susan Lord, Department of Medicine (Rehabilitation), Wellington School of Medicine and Health Sciences, PO Box 7343, Wellington Sth 6002, New Zealand, e-mail: [email protected]

Received 19th April 2007; returned for revisions 26th May 2007; revised manuscript accepted 5th June 2007.

Clinical Rehabilitation 22(3):p 215-225, March 2008.

Objective

This pilot randomized controlled trial evaluated an assistant-led, community-based intervention to improve community mobility and participation after stroke, and examined the potential for independent community ambulation in people with subacute stroke who present with moderate gait deficit.

Design

A multicentre, pilot randomized controlled trial.

Setting

Three hospitals and three community settings in New Zealand.

Subjects

Thirty post-acute, home-dwelling stroke survivors were randomly allocated to receive intervention in the community (n=14) or as hospital outpatients (n=16) twice a week for seven weeks.

Interventions

The community intervention involved practice of functional gait activities in community environments relevant to each participant. Hospital-based physiotherapy was based upon a Motor Relearning approach.

Main measures

The primary outcome measure was gait speed (m/min). Secondary outcomes included endurance (six-minute walk time), Activities-specific Confidence Balance Scale, and the Subjective Index of Physical and Social Outcomes measured at baseline, post intervention and six months.

Results

Large gains in gait speed were obtained for participants in both groups: community group mean (SD) 16 (16.1) m/min; physiotherapy group mean (SD) 15.9 (16.1) m/min, maintained at six months. There were no significant differences between groups for primary and secondary outcomes after treatment (pP=0.86 ANOVA) or at six months (pP=0.83 ANOVA). Only 11 participants reported independent community ambulation. Levels of social integration were low to moderate.

Conclusions

A community-based gait recovery programme appears a practicable alternative to routine physiotherapy, however independent community ambulation is a challenging rehabilitation goal.