At home physical therapy safer than high tech stroke rehabilitation
Physical therapy at home is found to get stroke patients moving and is safer than a comparative high-tech intervention, according to findings from Duke researchers.
According to findings from the NIH-funded study, Locomotor Experience Applied Post-Stroke (LEAPS), assisted treadmill training that take place in an inpatient rehabilitation facility was no more effective than a home based physical therapy program for helping stroke victims regain mobility.
Pamela Woods Duncan, PhD, PT, professor in the Doctor of Physical Therapy Division at Duke University and principal investigator of the a new study presented the findings at the American Stroke Association’s International Stroke Conference 2011.
According to Dr. Duncan, “This is important because the home-based intervention is more accessible, more feasible, and it was also associated with fewer risks in our study.” She explains, “There has been an emerging use of locomotor-style training in clinical practice, with some preliminary data in small trials that suggests that this is an effective intervention.”
Locomoter-style training involve multiple physical therapists who assist stroke patients with walking in a harness while suspended over a treadmill. The goal is to progress to walking on the ground. The treadmill intervention has gained popularity for stroke rehabilitation based on small trials showing benefits.
The LEAPS study is the first systematic Phase III trial that looked closely at different interventions that can help stroke patients who are prone to falls and fractures from loss of balance and strength.
The study took place over five years and included 408 patients, working with two to three physical therapists, who had a stroke. The study compared outcomes between locomotor-style training to at home physical therapy that included 1.5 hours of exercise three times a week for 12 weeks, assisted by a single physical therapist. Included were patients from six inpatient rehabilitation facilities in Florida and California.
The patients receiving physical therapy at home did equally as well as those given the high-tech treadmill intervention. All of the patients experienced improved quality of life, made gains in waking speed, improved balance, socialization and motor skill recovery.
At six-month evaluation, both interventions were found to be superior to usual care. “…the improvement from either one of these interventions is twice what you see when patients get usual care,” Duncan said. In addition, the researchers found when locomotor training is used early during stroke rehabilitation it puts patients at higher risk for falls.
The Duke researchers say they have been working for years to find the best interventions to help stroke patients regain walking ability, strength and balance. Dr. Duncan notes it’s important to focus on fall prevention programs.
The study shows physical therapy at home works just as well as high-tech inpatient locomotor-style treadmill training for stroke recovery. In the LEAPS trial patients given the treadmill intervention were also found to be at higher risk for falls when started early, making in home therapy safer.