Increasing the Amount and Intensity of Stepping Training During Inpatient Stroke Rehabilitation Improves Locomotor and Non-Locomotor Outcomes.
Christopher E Henderson, Abbey Plawecki, Emily Lucas and 5 others
PMID 36004813WHAT IT FOUND
Prioritizing high-intensity stepping in inpatient stroke rehab improved walking speed and distance compared to usual care.
This occurred without hurting balance or transfer scores. However, falls increased in the high-intensity group. The study was non-randomized and relied on historical controls.
Key findings
01Patients in the high-intensity stepping phase walked 129 meters further in the 6-minute walk test and 0.085 m/s faster in the 10-meter walk test compared to the usual-care phase.
02High-intensity stepping improved transfer and stair scores without negatively affecting balance scores, despite less direct practice on those specific tasks.
03The incidence of falls was significantly higher in the high-intensity phase compared to usual care.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study was not randomized. The comparison is between different groups of patients treated at different times, so changes in medical care or patient severity over the 3 years could influence results. The high-intensity phase had a higher rate of falls compared to usual care. Therapists only achieved the target heart rate intensity in 38% of sessions during the HIT phase, meaning the 'high-intensity' label reflects the attempt and average, not consistent achievement in every session. Patients in the HIT phase had worse baseline balance scores than those in usual care, which complicates direct comparison. Results are from a single site in the US, so they may not apply to other healthcare systems or staffing models.
Declared interests
Dr. Hornby is co-owner and Dr. Henderson is partially employed by the Institute of Knowledge Translation. The study was supported by the National Institutes of Health.
The easy way to misread this
Do not assume that high-intensity stepping is safe without enhanced fall prevention strategies. The study found a 2.2 times higher odds of falling in the high-intensity group compared to usual care. Additionally, because this was a non-randomized historical comparison, the improved outcomes might partly reflect other changes in care over time rather than just the stepping intervention.