Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
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.

PubMed Disclaimer

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

References

    1. Dickstein R. Rehabilitation of gait speed after stroke: a critical review of intervention approaches. Neurorehabil Neural Repair. 2008;22:649–660. - PubMed
    1. Dobkin B, Apple D, Barbeau H, et al. Methods for a randomized trial of weight-supported treadmill training versus conventional training for walking during inpatient rehabilitation after incomplete traumatic spinal cord injury. Neurorehabil Neural Repair. 2003;17:153–167. - PMC - PubMed
    1. Dobkin BH, Apple D, Barbeau H, et al. Weight-supported treadmill vs over-ground training for walking after acute incomplete SCI. Neurology. 2006;66:484–493. - PMC - PubMed
    1. Duncan PW, Sullivan KJ, Behrman AL, et al. Protocol for the Locomotor Experience Applied Post-stroke (LEAPS) trial: a randomized controlled trial. BMC Neurol. 2007;7:39. - PMC - PubMed
    1. Hidler J, Nichols D, Pelliccino M, et al. Multi-center randomized clinical trial evaluating the effectiveness of the Lokomat in sub-acute stroke. Neurorehabil Neural Repair. 2009;23:5–13. - PubMed

Publication types