Article

OBJECTIVE: To assess whether a downhill walking training programme is more
effective than the same amount of training applied uphill in chronic stroke
survivors. DESIGN: Randomized, single-blind study.
SETTING: Outpatient
rehabilitation service. METHODS: Thirty-eight adults with hemiplegia from stroke
lasting more than three months were randomly allocated to one of the two groups:
'UP' - 45 minutes of physical therapy + 30 minutes of treadmill with 5% ascending
slope; and 'DOWN' - 45 minutes of physical therapy + 30 minutes of treadmill with
5% descending slope. Both groups were treated 5 times a week for six weeks.
Patients were evaluated before treatment, at the end of treatment and after three
months. OUTCOME MEASURES: Primary outcome measure was the number of patients
showing an improvement in 6-minute walking test (6MWT) greater than 50 m.
Secondary outcome measures were: (1) number of patients showing a clinically
relevant improvement of gait speed during 10-m walking test (10mWT); (2) number
of patients showing an improvement in timed up and go (TUG) greater than minimal
detectable change. RESULTS: Both groups had a significant improvement after
treatment and at follow-up. At the end of treatment, compared to UP group, more
patients in the DOWN group showed clinically significant improvements in primary
and secondary outcomes (16/19 patients for 6MWT, 11/19 patients for 10mWT and
9/19 patients for TUG compared with 3/19, 4/19 and 2/19 patients, respectively, P
< 0.01). At follow-up, results were similar except for 10mWT. CONCLUSIONS: In
chronic stroke patients, downhill treadmill training produces a bigger effect
than uphill training.

Langue : ANGLAIS