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Clinical Trial
. 2010 Mar-Apr;24(3):235-42.
doi: 10.1177/1545968309357558.

International randomized clinical trial, stroke inpatient rehabilitation with reinforcement of walking speed (SIRROWS), improves outcomes

Bruce H Dobkin  1 , Prudence Plummer-D'Amato, Robert Elashoff, Jihey Lee; SIRROWS Group
Affiliations
Clinical Trial

International randomized clinical trial, stroke inpatient rehabilitation with reinforcement of walking speed (SIRROWS), improves outcomes

Bruce H Dobkin et al. Neurorehabil Neural Repair. 2010 Mar-Apr.

Abstract

Background: Feedback about performance may optimize motor relearning after stroke.

Objectives: Develop an international collaboration to rapidly test the potential efficacy of daily verbal feedback about walking speed during inpatient rehabilitation after stroke, using a protocol that requires no research funds.

Methods: This phase 2, single-blinded, multicenter trial randomized inpatients to either feedback about self-selected fast walking speed (daily reinforcement of speed, DRS) immediately after a single, daily 10-m walk or to no reinforcement of speed (NRS) after the walk, performed within the context of routine physical therapy. The primary outcome was velocity for a 15.2-m (50-foot) timed walk at discharge. Secondary outcomes were walking distance in 3 minutes, length of stay (LOS), and level of independence (Functional Ambulation Classification, FAC).

Results: Within 18 months, 179 participants were randomized. The groups were balanced for age, gender, time from onset of stroke to entry, initial velocity, and level of walking-related disability. The walking speed at discharge for DRS (0.91 m/s) was greater (P = .01) than that for NRS (0.72 m/s). No difference was found for LOS. LOS for both DRS and NRS was significantly shorter, however, for those who had mean walking speeds >0.4 m/s at entry. The DRS group did not have a higher proportion of FAC independent walkers (P = .1) and did not walk longer distances ( P = .09).

Conclusions: An Internet-based collaboration of 18 centers found that feedback about performance once a day produced gains in walking speed large enough to permit unlimited, slow community ambulation at discharge from inpatient rehabilitation.

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Conflict of interest statement

Declaration of Conflicting Interests

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Figures

Figure 1
Figure 1
CONSORT diagram of flow of participants through the randomized controlled trial Abbreviations: CONSORT, Consolidated Standards of Reporting Trials; DRS, daily reinforcement of walking speed; NRS, no reinforcement of walking speed.
See this image and copyright information in PMC

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References

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