Segal Neil A, Glass Natalie A, Teran-Yengle Patricia, Singh Bhupinder, Wallace Robert B, Yack H John
From the Department of Rehabilitation Medicine, University of Kansas, Kansas City, Kansas (NAS); and Department of Orthopaedics and Rehabilitation (NAG), Department of Physical Therapy and Rehabilitation Science (PT-Y, BS, HJY), and Department of Epidemiology (NAS, RBW), University of Iowa, Iowa City, Iowa.
Am J Phys Med Rehabil. 2015 Oct;94(10 Suppl 1):848-58. doi: 10.1097/PHM.0000000000000264.
The objective of this study was to determine whether individualized gait training is more effective than usual care for reducing mobility disability and pain in individuals with symptomatic knee osteoarthritis.
Adults aged 60 yrs or older with symptomatic knee osteoarthritis and mobility limitations were randomized to physical therapist-directed gait training on an instrumented treadmill, with biofeedback individualized to optimize knee movements, biweekly for 3 mos or usual care (control). Mobility disability was defined using Late Life Function and Disability Index Basic Lower Limb Function score (primary); mobility limitations, using timed 400-m walk, chair-stand, and stair-climb tests; and symptoms, using the Knee Injury/Osteoarthritis Outcome Score at baseline, as well as at 3, 6, and 12 mos. The analyses used longitudinal mixed models.
There were no significant intergroup differences between the 35 gait-training (74.3% women; age, 69.7 ± 8.2 yrs) and 21 control (57.1% women; age, 68.9 ± 6.5 yrs) participants at baseline. At 3 mos, the gait-training participants had greater improvement in mobility disability (4.3 ± 1.7; P = 0.0162) and symptoms (8.6 ± 4.1; P = 0.0420). However, there were no intergroup differences detected for pain, 400-m walk, chair-stand, or stair-climb times at 3 mos or for any outcomes at 6 or 12 mos.
Compared with usual care, individualized gait training resulted in immediate improvements in mobility disability knee symptoms in adults with symptomatic knee osteoarthritis, but these effects were not sustained.
本研究的目的是确定个体化步态训练在减轻有症状的膝关节骨关节炎患者的活动障碍和疼痛方面是否比常规护理更有效。
年龄在60岁及以上、有症状的膝关节骨关节炎且存在活动受限的成年人被随机分为两组，一组在配备仪器的跑步机上接受物理治疗师指导的步态训练，通过生物反馈进行个体化调整以优化膝关节运动，每两周进行一次，共3个月；另一组接受常规护理（对照组）。使用晚年功能与残疾指数基本下肢功能评分来定义活动障碍（主要指标）；通过400米定时步行、椅子站立和爬楼梯测试来评估活动受限情况；使用膝关节损伤/骨关节炎结局评分在基线以及3、6和12个月时评估症状。分析采用纵向混合模型。
在基线时，35名步态训练参与者（74.3%为女性；年龄，69.7±8.2岁）和21名对照组参与者（57.1%为女性；年龄，68.9±6.5岁）之间没有显著的组间差异。在3个月时，步态训练参与者在活动障碍（4.3±1.7；P = 0.0162）和症状（8.6±4.1；P = 0.0420）方面有更大改善。然而，在3个月时，两组在疼痛、400米步行、椅子站立或爬楼梯时间方面没有检测到组间差异，在6个月或12个月时的任何结局指标上也没有差异。
与常规护理相比，个体化步态训练使有症状的膝关节骨关节炎成年人的活动障碍和膝关节症状立即得到改善，但这些效果并未持续。
