Personalised gait training versus standard gait training programme among patients with stroke: A randomised controlled trial

Abstract

Background: Gait asymmetry after stroke can limit mobility and independence. Standard gait training may improve walking performance but may not address individual biomechanical deficits such as stance-phase asymmetry. This study aimed to compare personalised gait training (PGT) guided by real-time stance-phase analysis with standard gait training (SGT) in adults with subacute stroke. Methods: This randomised controlled trial included 120 adults aged 45–75 years with first-ever ischaemic stroke and moderate gait impairment. Participants were randomised 1:1 to PGT or SGT and received 45-minute sessions, five days per week for 12 weeks. PGT used instrumented insoles providing real-time feedback, with progression based on stance-phase symmetry. The primary outcome was Functional Independence Measure (FIM) locomotion at 12 weeks. Secondary outcomes included gait speed, Berg Balance Scale, stance-phase symmetry ratio (SPSR), and independent ambulation. Results: At 12 weeks, mean (standard deviation (SD)) FIM locomotion increased from 4.2 (1.3) to 6.6 (1.1) with PGT and from 4.0 (1.4) to 5.3 (1.4) with SGT, with a between-group difference of 1.3 points (95% CI 0.8–1.7; P <0.05; Cohen’s d=1.03). At 12 weeks, PGT also showed higher gait speed (0.94 (0.24) vs 0.68 (0.21) m/s), Berg Balance Scale score (50.2 (5.8) vs 42.8 (7.6)), and SPSR (1.02 (0.1) vs 0.9 (0.1)). Independent ambulation was achieved by 78% participants with PGT compared with 53% with SGT (OR=3.2, 95% CI 1.5–7.2). Time to independent ambulation was 2.3 weeks shorter with PGT (95% CI 1.5–3.1). Conclusion: Personalised stance-phase-guided gait training can improve functional mobility, gait performance, and independent ambulation compared with standard gait training in adults with subacute stroke.