Jones Michael L, Evans Nicholas, Tefertiller Candace, Backus Deborah, Sweatman Mark, Tansey Keith, Morrison Sarah
Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA.
Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA.
Arch Phys Med Rehabil. 2014 Dec;95(12):2247-52. doi: 10.1016/j.apmr.2014.07.401. Epub 2014 Aug 4.
To gain insight into who is likely to benefit from activity-based therapy (ABT), as assessed by secondary analysis of data obtained from a clinical trial.
Secondary analysis of results from a randomized controlled trial with delayed treatment design.
Outpatient program in a private, nonprofit rehabilitation hospital.
Volunteer sample of adults (N=38; 27 men; 11 women; age, 22-63y) with chronic (≥12mo postinjury), motor-incomplete (American Spinal Injury Association [ASIA] Impairment Scale [AIS] grade C or D) spinal cord injury (SCI).
A total of 9h/wk of ABT for 24 weeks including developmental sequencing; resistance training; repetitive, patterned motor activity; and task-specific locomotor training. Algorithms were used to guide group allocation, functional electrical stimulation utilization, and locomotor training progression.
Walking speed and endurance (10-meter walk test and 6-minute walk test) and functional ambulation (timed Up and Go test).
This secondary analysis identified likely responders to ABT on the basis of injury characteristics: AIS classification, time since injury, and initial walking ability. Training effects were the most clinically significant in AIS grade D participants with injuries <3 years in duration. This information, along with information about preliminary responsiveness to therapy (gains after 12wk), can help predict the degree of recovery likely from participation in an ABT program.
ABT has the potential to promote neurologic recovery and enhance walking ability in individuals with chronic, motor-incomplete SCI. However, not everyone with goals of walking recovery will benefit. Individuals with SCI should be advised of the time, effort, and resources required to undertake ABT. Practitioners are encouraged to use the findings from this trial to assist prospective participants in establishing realistic expectations for recovery.
通过对一项临床试验所得数据进行二次分析，深入了解哪些人可能从基于活动的疗法（ABT）中获益。
采用延迟治疗设计的随机对照试验结果的二次分析。
一家私立非营利性康复医院的门诊项目。
慢性（受伤后≥12个月）、运动不完全性（美国脊髓损伤协会[ASIA]损伤量表[AIS]C级或D级）脊髓损伤（SCI）的成年人志愿者样本（N = 38；男性27名；女性11名；年龄22 - 63岁）。
每周进行9小时的ABT，共24周，包括发育序列训练；阻力训练；重复性、有模式的运动活动；以及特定任务的运动训练。使用算法指导分组、功能性电刺激的使用和运动训练进展。
步行速度和耐力（10米步行试验和6分钟步行试验）以及功能性步行能力（定时起立行走试验）。
这项二次分析根据损伤特征（AIS分类、受伤时间和初始步行能力）确定了可能对ABT有反应者。训练效果在受伤时间<3年的AIS D级参与者中临床意义最为显著。这些信息，连同关于治疗初步反应性（12周后的改善情况）的信息，有助于预测参与ABT项目可能的恢复程度。
ABT有潜力促进慢性、运动不完全性SCI患者的神经恢复并提高步行能力。然而，并非所有以恢复步行能力为目标的人都会从中受益。应告知SCI患者进行ABT所需的时间、精力和资源。鼓励从业者利用该试验的结果帮助潜在参与者对恢复建立现实的期望。
