title: Who may have durable benefit from robotic gait training?: a 2-year follow-up randomized controlled trial in patients with subacute stroke.
abstract: OBJECTIVE
  Robotic-assisted walking training after stroke aims to enhance the odd of regaining independent gait. Recent studies have suggested that this approach is more effective than conventional therapy alone only in severely affected patients. We determined whether these results persist at long-term follow-up.
  
  
  METHODS
  Forty-eight nonambulant participants after subacute stroke were stratified by motricity index into high (<29) and low (≥29) motor impairment groups. Each arm was randomized to a robotic or control group at a mean of 20 days after stroke. All patients underwent 2 therapy sessions per day, 5 days per week, for 3 months. Robotic group subjects underwent 20 sessions of robotic-assisted gait training in the first 4 weeks of inpatient therapy and abbreviated conventional therapy, whereas control group patients received only conventional gait training. The primary outcome was Functional Ambulation Category, and secondary measures were the Rivermead Mobility Index and Barthel Index scores. The scales were administered before and after the inpatient stay and 2 years after discharge.
  
  
  RESULTS
  At follow-up, as at discharge, the low motricity robotic group improved more than the control group counterpart with regard to functional ambulation category (4.7±0.5 versus 3.1±1.5, P=0.002), Barthel Index (76.9±11.5 versus 64.7±14.0, P=0.024), and Rivermead Mobility Index (11.8±3.5 versus 7.0±3.6, P=0.010), whereas conventional and robotic therapies were equally effective in the high motricity groups.
  
  
  CONCLUSIONS
  The higher efficacy of the combination of robotic therapy and conventional therapy versus conventional therapy alone that was observed at discharge only in patients with greater motor impairments was sustained after 2 years.
authors.affiliation: Santa Lucia Foundation, IRCCS, via Ardeatina 306, 00179, Rome, Italy. g.morone@hsantalucia.it
authors.forename: Giovanni
authors.initials: G
authors.lastname: Morone
authors.forename: Marco
authors.initials: M
authors.lastname: Iosa
authors.forename: Maura
authors.initials: M
authors.lastname: Bragoni
authors.forename: Domenico
authors.initials: D
authors.lastname: De Angelis
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Venturiero
authors.forename: Paola
authors.initials: P
authors.lastname: Coiro
authors.forename: Raffaella
authors.initials: R
authors.lastname: Riso
authors.forename: Luca
authors.initials: L
authors.lastname: Pratesi
authors.forename: Stefano
authors.initials: S
authors.lastname: Paolucci
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005684:Gait; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities / Q000295:instrumentation*; D012371:Robotics; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation; D013997:Time Factors