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Repetitive locomotor training and physiotherapy improve walking and basic activities of daily living after stroke: a single-blind, randomized multicentre trial (DEutsche GAngtrainerStudie, DEGAS)

Klinik Bavaria, Neurological Rehabilitation, Kreischa, Germany

C Werner

Klinik Berlin, Department of Neurological Rehabilitation, Charité University Hospital, Berlin, Germany

M Holzgraefe

Asklepioskliniken Schildautal, Clinic for Neurological Rehabilitation and Early Rehabilitation, Seesen, Germany

G Kroczek

Medical Park Bad Rodach, Bad Rodach, J Mehrholz Klinik Bavaria, Neurological Rehabilitation, Kreischa, Germany

I Wingendorf

Asklepioskliniken Schildautal, Clinic for Neurological Rehabilitation and Early Rehabilitation, Seesen, Germany

G Hoölig

Medical Park Bad Rodach, Bad Rodach, Germany

R Koch

Institute for Medical Informatics and Biometrics of the Technical University Dresden, Germany

S Hesse

Klinik Berlin, Department of Neurological Rehabilitation, Charité University Hospital, Berlin, Germany

Objective: To evaluate the effect of repetitive locomotor training on an electromechanical gait trainer plus physiotherapy in subacute stroke patients.

Design: Randomized controlled trial.

Setting: Four German neurological rehabilitation centres. Subjects: One hundred and fifty-five non-ambulatory patients (first-time stroke <60 days).

Intervention: Group A received 20 min locomotor training and 25 min physiotherapy; group B had 45 min physiotherapy every week day for four weeks.

Main outcome measures: Primary variables were gait ability (Functional Ambulation Category, 0-5) and the Barthel Index (0-100), blindly assessed at study onset, end, and six months later for follow-up. Responders to the therapy had to become ambulatory (Functional Ambulation Category 4 or 5) or reach a Barthel Index of 75. Secondary variables were walking velocity, endurance, mobility and leg power.

Results: The intention-to-treat analysis revealed that significantly greater number of patients in group A could walk independently: 41 of 77 versus 17 of 78 in group B (P B < 0.0001) at treatment end. Also, significantly more group A patients had reached a Barthel Index 75: 44 of 77 versus 21 of 78 (P B < 0.0001). At six-month follow-up, the superior gait ability in group A persisted (54 of 77 versus 28 of 78, P B < 0.0001), while the Barthel Index responder rate did not differ. For all secondary variables, group A patients had improved significantly more (P B < 0.0001) during the treatment period, but not during follow-up.

Conclusions: Intensive locomotor training plus physiotherapy resulted in a significantly better gait ability and daily living competence in subacute stroke patients compared with physiotherapy alone.

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