Medicine (Baltimore). 2026 Nov 13;105(46):e51485. doi: 10.1097/MD.0000000000051485.
ABSTRACT
BACKGROUND: This study aimed to compare the effects of 3 weeks of slow-belt split-belt treadmill training (SBT) with those of tied-belt treadmill training (both belts driven at the same speed) on balance, functional reach, walking speed, and basic activities of daily living in patients with subacute stroke, and to evaluate the feasibility and safety of the SBT protocol.
METHODS: In this single-center, assessor-blinded, parallel-group pilot randomized controlled trial with 1:1 allocation conducted in the inpatient rehabilitation unit of a tertiary hospital, 30 patients with subacute hemiplegic stroke (median, 13 days after onset) were randomized; 26 participants (13 per group) completed the post-intervention assessment. Thirty 30-minute treadmill sessions (twice daily, 5 days per week, for 3 weeks) were delivered in place of the routine gait-training sessions of the standard inpatient rehabilitation program. In the SBT group, the paretic limb was positioned on the slower belt at a fixed paretic-to-nonparetic belt-speed ratio of 1:2; in the control group, both belts operated at the same speed. The primary outcome was the Berg Balance Scale (BBS) at 3 weeks, compared between groups using baseline-adjusted analysis of covariance. Secondary outcomes were the functional reach test (FRT), modified FRT, gait speed (10-m walk test), and Korean version of the modified Barthel index, with Holm adjustment for multiplicity.
RESULTS: Both groups improved substantially (BBS, +18.8 vs +18.0 points; both P <.001); however, the baseline-adjusted between-group difference in the BBS was not significant (1.20 points; 95% confidence interval = -5.30 to 7.71; P =.706). No secondary outcome remained significant after Holm adjustment; a nominal difference in seated FRT (adjusted difference = 9.75 cm; P =.044; Holm-adjusted P =.355) was not robust in sensitivity analyses. Session completion was 99.7%, and no device- or protocol-related adverse events occurred.
CONCLUSION: In this pilot trial of patients with subacute stroke undergoing inpatient rehabilitation, SBT was feasible and well tolerated but did not demonstrate superiority over tied-belt training for balance, walking speed, or activities of daily living. An exploratory signal in seated reach warrants confirmation in adequately powered trials.
PMID:43024285 | DOI:10.1097/MD.0000000000051485
