Christina Garrity, Darcy S Reisman, Sandra A Billinger, Katie A Butera, Pierce Boyne
{"title":"预测慢性中风中高强度运动训练后的步行能力结果。","authors":"Christina Garrity, Darcy S Reisman, Sandra A Billinger, Katie A Butera, Pierce Boyne","doi":"10.1097/NPT.0000000000000528","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Moderate-to-high intensity locomotor training (M-HIT) is strongly recommended in stroke rehabilitation, but outcomes are variable. This study aimed to identify baseline clinical characteristics that predict changes in walking capacity following M-HIT in chronic stroke.</p><p><strong>Methods: </strong>This analysis used data from the HIT-Stroke Trial (N = 55), which involved up to 36 sessions of either moderate- or high-intensity locomotor training. A prespecified model assessed how well baseline motor impairment (Fugl-Meyer lower limb motor scale [FM-LL]), comfortable gait speed (CGS), and balance confidence (Activities-specific balance confidence scale [ABC]) independently explain changes in 6-minute walk distance (∆6MWD), while controlling for the treatment group. Exploratory analysis tested additional baseline covariates using the all-possible regressions procedure. The predictive value of each potential covariate was assessed by its average contribution to the explained variance in ∆6MWD (∆pseudo-R2).</p><p><strong>Results: </strong>With the prespecified model, 8-week ∆6MWD was significantly associated with baseline FM-LL (β = 5.0 [95% CI: 1.4, 8.6]) and ABC (β = 0.7 [0.0, 1.4]), but not CGS (β = - 44.6 [-104.7, 15.6]). The exploratory analysis revealed that the top 7 covariates with the highest mean ∆pseudo-R2 were FM-LL, pain-limited walking duration, ABC, the use of an assistive device, fatigue, depression, and recent walking exercise history >2 days per week.</p><p><strong>Discussion and conclusions: </strong>On average, participants with less motor impairment and higher balance confidence exhibit greater walking capacity improvements after M-HIT in chronic stroke. Additional negative predictive factors may include pain-limited walking duration, use of an assistive device, fatigue, depression, and recent walking exercise; however, these exploratory findings need to be confirmed in future studies.</p><p><strong>Video abstract: </strong>Supplemental Digital Content available at [http://links.lww.com/JNPT/A533].</p>","PeriodicalId":49030,"journal":{"name":"Journal of Neurologic Physical Therapy","volume":" ","pages":""},"PeriodicalIF":4.2000,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Predicting Walking Capacity Outcomes After Moderate-to-High Intensity Locomotor Training in Chronic Stroke.\",\"authors\":\"Christina Garrity, Darcy S Reisman, Sandra A Billinger, Katie A Butera, Pierce Boyne\",\"doi\":\"10.1097/NPT.0000000000000528\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Moderate-to-high intensity locomotor training (M-HIT) is strongly recommended in stroke rehabilitation, but outcomes are variable. This study aimed to identify baseline clinical characteristics that predict changes in walking capacity following M-HIT in chronic stroke.</p><p><strong>Methods: </strong>This analysis used data from the HIT-Stroke Trial (N = 55), which involved up to 36 sessions of either moderate- or high-intensity locomotor training. A prespecified model assessed how well baseline motor impairment (Fugl-Meyer lower limb motor scale [FM-LL]), comfortable gait speed (CGS), and balance confidence (Activities-specific balance confidence scale [ABC]) independently explain changes in 6-minute walk distance (∆6MWD), while controlling for the treatment group. Exploratory analysis tested additional baseline covariates using the all-possible regressions procedure. The predictive value of each potential covariate was assessed by its average contribution to the explained variance in ∆6MWD (∆pseudo-R2).</p><p><strong>Results: </strong>With the prespecified model, 8-week ∆6MWD was significantly associated with baseline FM-LL (β = 5.0 [95% CI: 1.4, 8.6]) and ABC (β = 0.7 [0.0, 1.4]), but not CGS (β = - 44.6 [-104.7, 15.6]). The exploratory analysis revealed that the top 7 covariates with the highest mean ∆pseudo-R2 were FM-LL, pain-limited walking duration, ABC, the use of an assistive device, fatigue, depression, and recent walking exercise history >2 days per week.</p><p><strong>Discussion and conclusions: </strong>On average, participants with less motor impairment and higher balance confidence exhibit greater walking capacity improvements after M-HIT in chronic stroke. Additional negative predictive factors may include pain-limited walking duration, use of an assistive device, fatigue, depression, and recent walking exercise; however, these exploratory findings need to be confirmed in future studies.</p><p><strong>Video abstract: </strong>Supplemental Digital Content available at [http://links.lww.com/JNPT/A533].</p>\",\"PeriodicalId\":49030,\"journal\":{\"name\":\"Journal of Neurologic Physical Therapy\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":4.2000,\"publicationDate\":\"2025-08-08\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Neurologic Physical Therapy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/NPT.0000000000000528\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Neurologic Physical Therapy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/NPT.0000000000000528","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Predicting Walking Capacity Outcomes After Moderate-to-High Intensity Locomotor Training in Chronic Stroke.
Purpose: Moderate-to-high intensity locomotor training (M-HIT) is strongly recommended in stroke rehabilitation, but outcomes are variable. This study aimed to identify baseline clinical characteristics that predict changes in walking capacity following M-HIT in chronic stroke.
Methods: This analysis used data from the HIT-Stroke Trial (N = 55), which involved up to 36 sessions of either moderate- or high-intensity locomotor training. A prespecified model assessed how well baseline motor impairment (Fugl-Meyer lower limb motor scale [FM-LL]), comfortable gait speed (CGS), and balance confidence (Activities-specific balance confidence scale [ABC]) independently explain changes in 6-minute walk distance (∆6MWD), while controlling for the treatment group. Exploratory analysis tested additional baseline covariates using the all-possible regressions procedure. The predictive value of each potential covariate was assessed by its average contribution to the explained variance in ∆6MWD (∆pseudo-R2).
Results: With the prespecified model, 8-week ∆6MWD was significantly associated with baseline FM-LL (β = 5.0 [95% CI: 1.4, 8.6]) and ABC (β = 0.7 [0.0, 1.4]), but not CGS (β = - 44.6 [-104.7, 15.6]). The exploratory analysis revealed that the top 7 covariates with the highest mean ∆pseudo-R2 were FM-LL, pain-limited walking duration, ABC, the use of an assistive device, fatigue, depression, and recent walking exercise history >2 days per week.
Discussion and conclusions: On average, participants with less motor impairment and higher balance confidence exhibit greater walking capacity improvements after M-HIT in chronic stroke. Additional negative predictive factors may include pain-limited walking duration, use of an assistive device, fatigue, depression, and recent walking exercise; however, these exploratory findings need to be confirmed in future studies.
Video abstract: Supplemental Digital Content available at [http://links.lww.com/JNPT/A533].
期刊介绍：
The Journal of Neurologic Physical Therapy (JNPT) is an indexed resource for dissemination of research-based evidence related to neurologic physical therapy intervention. High standards of quality are maintained through a rigorous, double-blinded, peer-review process and adherence to standards recommended by the International Committee of Medical Journal Editors. With an international editorial board made up of preeminent researchers and clinicians, JNPT publishes articles of global relevance for examination, evaluation, prognosis, intervention, and outcomes for individuals with movement deficits due to neurologic conditions. Through systematic reviews, research articles, case studies, and clinical perspectives, JNPT promotes the integration of evidence into theory, education, research, and practice of neurologic physical therapy, spanning the continuum from pathophysiology to societal participation.
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