Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA.
Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA.
Arch Phys Med Rehabil. 2018 Aug;99(8):1591-1598. doi: 10.1016/j.apmr.2018.01.031. Epub 2018 Mar 3.
To investigate the relation of gait training (GT) during inpatient rehabilitation (IPR) to outcomes of people with traumatic spinal cord injury (SCI).
Prospective observational study using the SCIRehab database.
Six IPR facilities.
Patients with new SCI (N=1376) receiving initial rehabilitation.
Patients were divided into groups consisting of those who did and did not receive GT. Patients were further subdivided based on their primary mode of mobility as measured by the FIM.
Pain rating scales, Patient Health Questionnaire Mood Subscale, Satisfaction With Life Scale, and Craig Handicap Assessment and Reporting Technique (CHART).
Nearly 58% of all patients received GT, including 33.3% of patients who were primarily using a wheelchair 1 year after discharge from IPR. Those who used a wheelchair and received GT, received significantly less transfer and wheeled mobility training (P<.001). CHART physical independence (P=.002), mobility (P=.024), and occupation (P=.003) scores were significantly worse in patients who used a wheelchair at 1 year and received GT, compared with those who used a wheelchair and did not receive GT in IPR. Older age was also a significant predictor of worse participation as measured by the CHART.
A significant percentage of individuals who are not likely to become functional ambulators are spending portions of their IPR stays performing GT, which is associated with less time allotted for other functional interventions. GT in IPR was also associated with participation deficits at 1 year for those who used a wheelchair, implying the potential consequences of opportunity costs, pain, and psychological difficulties of receiving unsuccessful GT. Clinicians should consider these data when deciding to implement GT during initial IPR.
研究住院康复期间步态训练（GT）与创伤性脊髓损伤（SCI）患者康复结果的关系。
使用 SCIRehab 数据库进行前瞻性观察研究。
六家住院康复机构。
接受初始康复的新 SCI 患者（N=1376）。
将患者分为接受 GT 组和未接受 GT 组。根据 FIM 测量的主要移动方式，患者进一步分为亚组。
疼痛评分量表、患者健康问卷情绪子量表、生活满意度量表和 Craig 残疾评估和报告技术（CHART）。
近 58%的患者接受了 GT，其中 33.3%的患者在 IPR 出院后 1 年主要使用轮椅。使用轮椅并接受 GT 的患者接受的转移和轮椅移动训练明显较少（P<.001）。在 IPR 中使用轮椅且接受 GT 的患者，1 年后 CHART 身体独立性（P=.002）、移动能力（P=.024）和职业（P=.003）评分明显更差，而在 IPR 中使用轮椅且未接受 GT 的患者则没有。年龄较大也是 CHART 测量的参与度较差的显著预测因素。
相当一部分不太可能成为功能性步行者的人在住院康复期间的部分时间内进行 GT，这与其他功能干预的时间分配减少有关。在 IPR 中进行 GT 还与使用轮椅的患者 1 年后的参与度缺陷有关，这暗示了接受不成功 GT 的机会成本、疼痛和心理困难的潜在后果。临床医生在决定在初始 IPR 期间实施 GT 时应考虑这些数据。
