Walking training helps to improve walking ability and possibly self-care after stroke

Peurala S, Karttunnen AH, Sjögren T, et al. Evidence for the effectiveness of walking training on walking and self-care after stroke: A systematic review and meta-analysis of randomized controlled trials J Rehabil Med. 2014;46:387-399.

Review question

Does walking training after a stroke improve a patient’s ability to walk and take care of themselves? Are specific walking training programs (using a treadmill or other types of walking training devices) more effective than traditional walking training (using walking aids such as walkers or canes) or physiotherapy?

Background

In many western countries, stroke is one of the main causes of disability and can have a large impact on daily activities such as the ability to get in and out of bed, dress and walk independently. Intensive physiotherapy starting soon after a stroke can help people recover better and faster. Few studies have looked at the benefits of walking training, but knowing more can help health professionals to design the best types of rehabilitation programs for people who have had a stroke.

How the review was done

The researchers conducted a systematic review of 38 randomized controlled trials of adult stroke patients. Only good or high quality studies were included in this review.  Walking training included walking with aids, walking on a treadmill or using other types of walking training devices and encouragement and guidance by a therapist. The review compared 3 rehabilitation sub-groups:

• 7 studies compared walking training  to no treatment or placebo treatment
• 11 studies compared walking training  to overall physiotherapy
• 21 studies compared specific walking training programs  to traditional walking training

The researchers measured changes in walking speed, walking distance, walking independence and the patient’s ability to care for themselves to find out if walking training programs helped with stroke recovery.

What the researchers found

For patients 1 to 6 months after a stroke, specific walking training (including musical feedback and treadmill training) helped to improve walking speed and distance more than traditional walking training. For patients over 6 months after a stroke, any type of walking training helped improve walking ability, speed and distance compared to people receiving no treatment, placebo treatment or physiotherapy. On average, 20-60 min training sessions 3-5 times a week for at least 4 weeks were needed to make a difference. Walking training also appeared to have some benefit in improving patients’ ability to care for themselves.

Conclusion

Walking training improves walking speed, distance and ability – even many months after a stroke – and may help to improve patient self-care for people who have had a stroke. For walking training to be effective, sessions should be 3 to 5 times per week and last between 20 to 60 minutes.