Does functional strength training of the leg in subacute stroke improve physical performance? A pilot randomized controlled trial

Objective: To examine the effect of functional strength training in subacute stroke. Design: A single-blinded randomized controlled trial. Setting: Two rehabilitation units. Subjects: Eighteen patients in the subacute phase post stroke, randomly allocated to a functional strength training (intervention) group (n=8) and a training-as-usual (comparison) group (n=10). Intervention: The functional strength training group participated in functional progressive strength training of the affected lower extremity. The training-as-usual group had traditional training, excessive muscle power being avoided to prevent associated reactions. All trained 50 minutes five days a week for four weeks. Main measures: Maximum weight-bearing in standing (primary outcome), isometric muscle strength, gait speed and items of Motor Assessment Scale. Results: Maximum weight-bearing on the affected leg improved more in the functional strength training group (mean 17.4% of body weight) than in the training-as-usual group (mean 5.6% of body weight), but taking test data at inclusion into consideration, the difference in change was not statistically significant (P=0.056). More patients in the functional strength training group (57%) could weight-bear on the affected leg while stepping forward, than in the training-as-usual group (17%). Improvement was clinically significant in 7 of 9 outcome measures in the functional strength training group (effect size >= 0.80, large), but in only 3 of 9 in the training-as-usual group. All patients in the functional strength training group and 70% of the patients in the training-as-usual group rated their overall status as 'much' or 'very much' improved. Conclusions: This pilot study indicates that functional strength training of lower extremities improves physical performance more than traditional training.