How feasible is the delivery of treadmill training early after stroke within the NHS: Findings of a Phase II randomised controlled trial
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Smith, M., Baer, G., Dennis, M., Pitman, D. & Salisbury, L. (2009) How feasible is the delivery of treadmill training early after stroke within the NHS: Findings of a Phase II randomised controlled trial, International Journal of Stroke, vol. 4, pp. 38.
Introduction: RCP Stroke Guidelines advocate treadmill training (TT) for gait rehabilitation post-stroke. The protocols described in previous studies were intensive, short-term and may not be feasible to deliver within a UK clinical setting. One aim of this Phase II study was to explore key elements of delivering TT in a clinical setting within the NHS. Method: As part of a randomised controlled trial over 8 weeks, participants with stroke were allocated to a control or experimental group. The protocol demanded that all participants received a minimum of three therapy sessions per week of which at least two were on the treadmill for experimental participants. A treadmill system with unweighing harness was used. The content of treadmill sessions was decided by the treating therapists and all parameters were recorded. Results: Seventy-seven participants were recruited with 39 randomised to the experimental group. Experimental participants received a median of two treadmill sessions per week, with an average total walking time on the treadmill of between 8 and 16 min/week, at a median speed of 0.6m/s. Use of a support harness by participants reduced from 49% in week 1 to 23% in week 8. Conclusion: Only the minimum number of treadmill interventions were delivered. Clinical staff cited staffing levels, number of staff required for safety and time required for harness application as some of the reasons for the limited TT. These findings suggest that it may not be feasible to deliver sufficient doses of TT within the current NHS clinical environment.