Gait-Adaptability Training in People With Hereditary Spastic Paraplegia: A Randomized Clinical Trial.

The study was conducted at one center with 36 participants. The assessor was not blinded and also delivered training, which can affect measured walking outcomes. Participants were not blinded, and the content of usual care was not described, so the difference between groups may have been small. The training period was only 5 weeks, and it is unknown whether longer training or booster sessions would change the result. A secondary outcome, the single-run WALT, favored training, but it was a secondary comparison and the primary outcome was not significant. Physical therapy co-interventions were uneven: 10 of 18 training participants received it, averaging 70 minutes per week, while 6 of 18 control participants received it, averaging 100 minutes per week. Two participants could not complete the WALT, and two fall diaries were not analyzed. The control group improved during waiting-list, possibly due to awareness of being observed or after pandemic-related activity changes. Participants did not give qualitative feedback on how they experienced the training. The utility of the WALT still needs investigation. A ceiling effect on the obstacle task could not be fully ruled out, although only 6 of 36 participants completed it within the healthy control range.

No author conflicts of interest were declared. The study was funded by the Jacques und Gloria Gossweiler Foundation, and Ipsen Pharmaceuticals supported the costs of the physiotherapists delivering the training. The funders were not involved in the protocol, execution, analyses, or interpretation.

Do not conclude that C-Mill gait-adaptability training improves walking more than usual care. The primary obstacle task showed no clear difference between groups, and the control group also improved after usual care and assessment. The positive single-run WALT was a secondary result among many and does not change the main finding.