Long-term retention effects of overground walk-slip training on clinical outcomes among people with hemiparetic stroke.

Abstract

Background: A single session of perturbation-based training (PBT) reduces fall-risk and enhances reactive balance control in people with stroke (PwS). However, its long-term effect on clinical outcomes remains unclear. This study examined the retention effects of a single session of overground walk-PBT on clinical measures of body structure and function, activity limitation, and participation restriction in PwS.

Methods: Forty-eight PwS were randomized to training (n = 25) or control (n = 23) groups. Participants completed baseline, 6- and 12-month sessions, including reactive balance and clinical assessments. The training group underwent overground walk-PBT, while the control group completed unperturbed walking alone. Outcomes were assessed using the International Classification of Functioning, Disability, and Health (ICF) framework: body structure and function (Modified Rankin Scale, Activities-specific Balance Confidence - ABC), activity limitation (Berg Balance Scale, Timed Up and Go - TUG, 10-Meter Walk Test - 10MWT, 6-Minute Walk Test), and participation restriction (Community Integration Questionnaire - CIQ). A Two-way ANOVA examined group × time interactions on all outcomes followed by post-hoc comparisons.

Results: Significant group × time interactions were observed for ABC, TUG, 10MWT, and CIQ (p < 0.05). The training group demonstrated improvements from baseline to 6 months (p < 0.02), with no differences between the 6- and 12-month sessions (except improvements in CIQ) (p > 0.02). The control group showed no improvements (p > 0.02) and demonstrated a reduction in balance confidence from baseline to 6-months (p < 0.02).

Conclusion: A single session of overground walk-PBT showed long-term improvements in outcomes across all ICF domains, highlighting its clinical utility as an effective rehabilitation strategy for PwS.