Recommended Outcome Measures for Stroke Patients Undergoing Lokomat Training
For stroke patients undergoing Lokomat (robotic-assisted locomotor training), the Fugl-Meyer Lower Extremity scale should be used as the primary outcome measure, with the 10-meter walk test, 6-minute walk test, and Timed Up and Go test as key secondary measures to comprehensively assess motor function and mobility improvements.
Primary Outcome Measures
Impairment Level Assessment
- Fugl-Meyer Lower Extremity (FM-LE) scale: Strongly recommended as the primary outcome measure for assessing motor recovery in patients undergoing Lokomat training 1. This measure:
- Shows the strongest evidence for validity in chronic stroke populations
- Has established minimal clinically important difference (MCID)
- Is highly recommended by the StrokEDGE consensus panel
- Directly measures neurological impairment and recovery at the body function level
Secondary Outcome Measures
Functional Mobility Assessment
10-meter walk test: Essential for measuring comfortable walking speed 1
- Simple to administer
- Provides quantitative data on walking speed
- Has established MCID
- Recommended at all time points from early subacute to chronic phases
Timed Up and Go (TUG) test: Specifically shown to improve with Lokomat training 2, 3
- Measures functional mobility including sit-to-stand, walking, and turning
- Meta-analysis shows significant improvements with Lokomat training (pooled mean difference = -3.40 seconds)
- Particularly sensitive to changes in balance and mobility after robotic training
6-minute walk test: Recommended for assessing walking endurance 1
- Evaluates cardiovascular endurance and walking capacity
- Has established MCID
- More comprehensive than the 10-meter test for assessing functional walking capacity
Balance Assessment
- Berg Balance Scale: Should be included to specifically measure balance outcomes 1, 2
- Comprehensive assessment of static and dynamic balance
- While meta-analysis shows inconclusive results specific to Lokomat training, it remains an important standardized measure
Functional Independence and Quality of Life
Functional Ambulation Category (FAC): Important for measuring gait independence 3
- Classifies walking ability from 0 (non-functional) to 5 (independent)
- Shown to improve with Lokomat training in recent studies
Stroke Impact Scale: Recommended for patient-reported outcomes 1
- Captures quality of life and perceived recovery
- Has established MCID
- Provides insight into meaningful functional improvements from the patient's perspective
Timing of Assessments
- Baseline assessment: Prior to beginning Lokomat training
- Post-intervention assessment: Immediately after completing the training program
- Follow-up assessment: At 3 months post-intervention to evaluate retention of gains 4
- Additional follow-up: Consider 6-month assessment for chronic stroke patients 1
Clinical Implementation Considerations
Comprehensive approach: Use a combination of impairment-level (FM-LE), activity-level (walking tests), and participation-level (Stroke Impact Scale) measures for a complete picture of recovery.
Avoid common pitfalls:
- Don't rely solely on walking speed as the only outcome measure
- Don't substitute kinematic measures for validated clinical scales
- Don't overlook the importance of follow-up assessments to determine long-term effects
Measurement of training parameters:
- Document Lokomat settings used (guidance level, speed, body weight support) as these affect muscle activity 5
- Speed is the most influential parameter affecting muscle activation during training
Balance specific considerations:
- Include balance-specific measures as Lokomat training has shown positive effects on balance recovery 2
- TUG and Rivermead Mobility Index are particularly sensitive to balance changes with Lokomat training
By implementing this comprehensive assessment protocol, clinicians can effectively track motor recovery, functional improvements, and quality of life changes in stroke patients undergoing Lokomat training, with the Fugl-Meyer Lower Extremity scale serving as the cornerstone primary outcome measure.