International Randomized Clinical Trial, Stroke Inpatient Rehabilitation With Reinforcement of Walking Speed (SIRROWS), Improves Outcomes

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.