title: Effects of task-specific and impairment-based training compared with usual care on functional walking ability after inpatient stroke rehabilitation: LEAPS Trial.
abstract: BACKGROUND
  After inpatient stroke rehabilitation, many people still cannot participate in community activities because of limited walking ability.
  
  
  OBJECTIVE
  To compare the effectiveness of 2 conceptually different, early physical therapy (PT) interventions to usual care (UC) in improving walking 6 months after stroke.
  
  
  METHODS
  The locomotor experience applied post-stroke (LEAPS) study was a single-blind, randomized controlled trial conducted in 408 adults with disabling hemiparetic stroke. Participants were stratified at baseline (2 months) by impairment in walking speed: severe (<0.4 m/s) or moderate (0.4 to <0.8 m/s). Between 2 and 6 months, they received either only UC (n = 143) or UC plus 36 therapist-provided sessions of either (1) walking training on a treadmill using body-weight support and practice overground at clinics (locomotor training program [LTP], n = 139) or (2) impairment-based strength and balance exercise at home (home exercise program [HEP], n = 126).
  
  
  RESULTS
  LTP participants were 18% more likely to transition to a higher functional walking level: severe to >0.4 m/s and moderate to >0.8 m/s than UC participants (95% confidence interval [CI] = 7%-29%), and HEP participants were 17% more likely to transition (95% CI = 5%-29%). Mean gain in walking speed in LTP participants was 0.13 m/s greater (95% CI = 0.09-0.18) and in HEP participants, 0.10 m/s greater (95% CI = 0.05-0.14) than in UC participants.
  
  
  CONCLUSIONS
  Progressive PT, using either walking training on a treadmill and overground, conducted in a clinic, or strength and balance exercises conducted at home, was superior to UC in improving walking, regardless of severity of initial impairment.
authors.affiliation: University of Florida, Gainesville, FL, USA. snadeau@ufl.edu
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Nadeau
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Wu
authors.forename: Bruce H
authors.initials: BH
authors.lastname: Dobkin
authors.forename: Stanley P
authors.initials: SP
authors.lastname: Azen
authors.forename: Dorian K
authors.initials: DK
authors.lastname: Rose
authors.forename: Julie K
authors.initials: JK
authors.lastname: Tilson
authors.forename: Steven Y
authors.initials: SY
authors.lastname: Cen
authors.forename: Pamela W
authors.initials: PW
authors.lastname: Duncan
mesh_terms: D000368:Aged; D005081:Exercise Therapy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function / Q000502:physiology*; D055070:Resistance Training / Q000009:adverse effects / Q000379:methods; D016037:Single-Blind Method; D000071939:Stroke Rehabilitation; D013997:Time Factors; D016138:Walking / Q000502:physiology*