High-Dose Walking Booster Program Is Feasible for People After Stroke: A Phase II Randomized Trial

BACKGROUND: Maintaining walking ability in the long term after a stroke is challenging. Furthermore, access to ongoing physiotherapy is limited. This trial determined the feasibility of a clinical trial of a high-dose walking booster program (HiWalk) and measured clinical outcomes. METHODS: A multisite, assessor-blinded pilot and feasibility randomized trial was conducted in Australia (June 2023 to July 2024). Participants had a stroke 6 months to 8 years prior and could walk unaided at 0.4 m/s to 1.0 m/s. The experimental group received HiWalk plus usual care, while the control group received usual care alone. HiWalk was group-based motor training to improve walking, 43 hours over 3 weeks. Feasibility outcomes included recruitment and retention. Clinical outcomes included walking speed (preferred and fast over 5 m, fast over 6 minutes), and self-efficacy at 1 and 6 months. RESULTS: Eighty-two individuals were screened, and 47 participated: age 58 (SD, 16), time poststroke 2.7 years (SD, 2.1), and baseline fast walking speed 0.9 m/s (SD, 0.4). Feasibility outcomes: the HiWalk trial was feasible in terms of recruitment (refusal rate 27%), retention at 1 month (98%), adherence (mean 91% [SD 13] attendance once commenced), safety (minor adverse events 0.4/wk), and measurement (98% of data collected at 1 month). Clinical outcomes: at month 1, there was a beneficial effect on a 30-point self-efficacy scale (mean difference, 3.0 [95% CI, 0.1–5.9]). However, despite a small positive mean effect of HiWalk on fast walking speed (mean difference, 0.05 m/s [95% CI, −0.09 to 0.19]), there were no other significant between group differences. Exploratory analysis suggests the effect on walking speed for those not undertaking rehabilitation was 0.24 m/s (95% CI, 0.06–0.43) more than for those who were. CONCLUSIONS: The HiWalk booster program was a feasible way to deliver mobility training in the community after stroke. Benefits in clinical outcomes were found for the subgroup of participants no longer undertaking rehabilitation. Therefore, future research should target this subpopulation. REGISTRATION: URL: https://www.anzctr.org.au ; Unique identifier: ACTRN12623000316606.