Predicting Walking Capacity Outcomes After Moderate to High Intensity Locomotor Training in Chronic Stroke

PurposeModerate-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 change in walking capacity following M-HIT in chronic stroke. MethodsThis 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 Balance Confidence scale [ABC]), independently explain changes in 6-minute walk distance ({Delta}6MWD), while controlling for treatment group. Exploratory analysis tested additional baseline covariates using the all-possible regressions procedure. The prognostic value of each potential covariate was assessed by its average contribution to the explained variance in {Delta}6MWD ({Delta} pseudo-R2). ResultsWith the prespecified model, 8-week {Delta}6MWD was significantly associated with baseline FM-LL ({beta}=5.0 [95% CI: 1.4, 8.6]) and ABC ({beta}=0.7 [0.0, 1.4]), but not CGS ({beta}=-44.6 [-104.7, 15.6]). The exploratory analysis revealed the top 7 covariates with the highest mean {Delta} 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. ConclusionsOn average, participants with less motor impairment and higher balance confidence have greater walking capacity improvements after M-HIT in chronic stroke. Additional negative prognostic factors may include pain-limited walking duration, use of an assistive device, fatigue, depression, and recent walking exercise but these exploratory findings need to be confirmed in future studies.