title: Varied overground walking training versus body-weight-supported treadmill training in adults within 1 year of stroke: a randomized controlled trial.
abstract: BACKGROUND
  Although task-related walking training has been recommended after stroke, the theoretical basis, content, and impact of interventions vary across the literature. There is a need for a comparison of different approaches to task-related walking training after stroke.
  
  
  OBJECTIVE
  To compare the impact of a motor-learning-science-based overground walking training program with body-weight-supported treadmill training (BWSTT) in ambulatory, community-dwelling adults within 1 year of stroke onset.
  
  
  METHODS
  In this rater-blinded, 1:1 parallel, randomized controlled trial, participants were stratified by baseline gait speed. Participants assigned to the Motor Learning Walking Program (MLWP) practiced various overground walking tasks under the supervision of 1 physiotherapist. Cognitive effort was encouraged through random practice and limited provision of feedback and guidance. The BWSTT program emphasized repetition of the normal gait cycle while supported on a treadmill and assisted by 1 to 3 therapy staff. The primary outcome was comfortable gait speed at postintervention assessment (T2).
  
  
  RESULTS
  In total, 71 individuals (mean age = 67.3; standard deviation = 11.6 years) with stroke (mean onset = 20.9 [14.1] weeks) were randomized (MLWP, n = 35; BWSTT, n = 36). There was no significant between-group difference in gait speed at T2 (0.002 m/s; 95% confidence interval [CI] = -0.11, 0.12; P > .05). The MLWP group improved by 0.14 m/s (95% CI = 0.09, 0.19), and the BWSTT group improved by 0.14 m/s (95% CI = 0.08, 0.20).
  
  
  CONCLUSIONS
  In this sample of community-dwelling adults within 1 year of stroke, a 15-session program of varied overground walking-focused training was not superior to a BWSTT program of equal frequency, duration, and in-session step activity.
authors.affiliation: McMaster University, Hamilton, ON, Canada St Joseph's Healthcare Hamilton, Hamilton, ON, Canada University Health Network, Toronto, ON, Canada depauv@mcmaster.ca.
authors.forename: Vincent G
authors.initials: VG
authors.lastname: DePaul
authors.affiliation: McMaster University, Hamilton, ON, Canada.
authors.forename: Laurie R
authors.initials: LR
authors.lastname: Wishart
authors.affiliation: McMaster University, Hamilton, ON, Canada.
authors.forename: Julie
authors.initials: J
authors.lastname: Richardson
authors.affiliation: McMaster University, Hamilton, ON, Canada.
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
authors.affiliation: McMaster University, Hamilton, ON, Canada.
authors.forename: Jinhui
authors.initials: J
authors.lastname: Ma
authors.affiliation: McMaster University, Hamilton, ON, Canada.
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Lee
mesh_terms: D000368:Aged; D001835:Body Weight; D005080:Exercise Test; D005081:Exercise Therapy; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000534:rehabilitation*; D006801:Humans; D008875:Middle Aged; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D016138:Walking
keywords: learning; motor skill; physical therapy; stroke; walking