Physiotherapist-Led Split-Belt Treadmill Gait Retraining for Individuals With Subacute Stroke: A Randomized Controlled Trial

Stroke is a leading cause of long-term disability in adults. Although many individuals regain independent walking ability following stroke, nearly 50% experience persistent gait impairments characterized by asymmetrical walking patterns, slower walking speed, impaired balance, and increased fall risk. These persistent mobility limitations highlight the continued need for innovative rehabilitation strategies that improve gait function during stroke recovery. Split-belt treadmill walking (SBTW), in which each leg walks at a different belt speed, has demonstrated potential to improve step length symmetry in individuals with chronic stroke. However, the effects of SBTW during the subacute stage of stroke recovery, within the first 9 months post-stroke when neuroplasticity may be heightened, remain largely unknown. In addition, previous SBTW studies have not integrated active physiotherapist-led gait retraining into the intervention, despite physiotherapist-led gait rehabilitation representing standard clinical care following stroke. The purpose of this randomized controlled trial is to compare physiotherapist-led gait retraining using a traditional treadmill training protocol to physiotherapist-led gait retraining integrated with a split-belt treadmill training protocol during the first 9 months post-stroke. The study aims to examine the effectiveness of the use of split-belt treadmill training to augment physiotherapist-led gait retraining to improve between-leg gait symmetry and overground walking speed.