Results from the largest randomized clinical trial to date regarding rehabilitation after stroke were published in the May 26th issue of the New England Journal of Medicine. The study called Locomotor Experience Applied Post-Stroke or LEAPS investigated approximately 408 patients recruited from 6 inpatient rehabilitation sites in California and Florida. Approximately two months after having a stroke, all of the participants were assigned to one of three treatment groups: home exercise with a physical therapist, body-weight-supported treadmill training at two months after the stroke (early locomotor training), or body-weight-supported treadmill training at six months after the stroke (late locomotor training). All participants received three sessions per week (90 minutes' duration) for a total to 30 to 36 sessions overall.
Given more than four million stroke survivors experience difficulties in walking, the primary outcome to be measured was improvements in the functional level of walking approximately one year after the stroke (metrics such as walking speed, balance, falls). The investigators hypothesized that locomotor training, especially early locomotor training, would be superior to a home exercise program.
At approximately one year, increased functional walking ability was observed in 52% of all participants. However, interestingly, no significant differences in improvement were found between early locomotor training and home exercise or between late locomotor training and home exercise. On the other hand, compared with the home exercise group, each of the locomotor training groups reported a higher frequency of dizziness or faintness during treatment.
Despite the high incidence of stroke, there remain a limited number of studies examining post-stroke rehabilitation and recovery. This study presents strong evidence to the importance of initiating physical therapy for stroke patients, with over half observing improvements within the year. This study also proves that physical therapy at home can be just as effective as more expensive, locomotor training solutions such as robot-assisted treadmill steppers. Also, not only was the home-based program found to be cheaper, it was also accompanied by fewer risks. As hospitals continue to evaluate best practices on post-stroke care, physical therapy/rehab will undoubtedly remain an important piece, with the optimal methods of delivery being the primary question to be addressed.