Department of Neurology, Oregon Health & Science University, Portland, OR.
Veterans Affairs Portland Health Care System, Portland, OR.
Arch Phys Med Rehabil. 2018 Oct;99(10):2050-2058. doi: 10.1016/j.apmr.2018.05.023. Epub 2018 Jun 26.
To evaluate the effect of the Assistive Device Selection, Training and Education Program (ADSTEP) on falls and walking and sitting activity in people with multiple sclerosis (PwMS).
Randomized controlled trial.
Veterans affairs medical center.
PwMS (N=40) using a walking aid at baseline who had fallen in the previous year.
Participants were randomly assigned to ADSTEP or control. ADSTEP had 6 weekly, 40-minute, 1-on-1 sessions with a physical therapist, starting with walking aid selection and fitting, followed by task-oriented progressive gait training. Control was usual medical care with the option of ADSTEP after the study.
The following were assessed at baseline, intervention completion, and 3 months later: falls, timed Up and Go, timed 25-foot walk, 2-minute walk, Four Square Step Test, International Physical Activity Questionnaire, Quebec User Evaluation of Satisfaction with Assistive Technologies, Multiple Sclerosis Walking Scale-12, Activities-Specific Balance Confidence Scale, and Multiple Sclerosis Impact Scale-29. Effect on these outcomes was estimated by a 2-by-2 repeated measures general linear model.
Fewer ADSTEP than control participants fell (χ=3.96, P<.05. number needed to treat =3.3). Time spent sitting changed significantly differently with ADSTEP than with control from baseline to intervention completion (F=11.16, P=.002. ADSTEP: reduced 87.00±194.89min/d; control: increased 103.50±142.21min/d; d=0.88) and to 3-month follow-up (F=9.25, P=.004. ADSTEP: reduced 75.79±171.57min/d; control: increased 84.50±149.23min/d; d=0.79). ADSTEP yielded a moderate effect on time spent walking compared to control at 3-month follow-up (P>.05. ADSTEP 117.53±148.40min/d; control 46.43±58.55min/d; d=0.63).
ADSTEP prevents falls, reduces sitting, and may increase walking in PwMS.
评估辅助设备选择、训练和教育计划（ADSTEP）对多发性硬化症患者（PwMS）跌倒和行走及坐立活动的影响。
随机对照试验。
退伍军人事务医疗中心。
基线时使用助行器且在过去一年中跌倒过的 PwMS（N=40）。
参与者被随机分配到 ADSTEP 或对照组。ADSTEP 每周进行 6 次、每次 40 分钟、1 对 1 的物理治疗师治疗，从助行器选择和适配开始，随后进行以任务为导向的渐进步态训练。对照组为常规医疗护理，研究结束后可选择 ADSTEP。
在基线、干预完成和 3 个月后评估以下指标：跌倒、计时起立行走测试、计时 25 英尺行走测试、2 分钟步行测试、四方步测试、国际体力活动问卷、魁北克用户对辅助技术满意度评估、多发性硬化步行量表-12、活动特异性平衡信心量表和多发性硬化影响量表-29。通过 2 乘 2 重复测量一般线性模型估计对这些结果的影响。
ADSTEP 组跌倒的参与者少于对照组（χ=3.96，P<.05，需要治疗的人数=3.3）。与对照组相比，ADSTEP 组从基线到干预完成时的坐姿时间显著减少（F=11.16，P=.002，ADSTEP：减少 87.00±194.89 分钟/天；对照组：增加 103.50±142.21 分钟/天；d=0.88），到 3 个月随访时也显著减少（F=9.25，P=.004，ADSTEP：减少 75.79±171.57 分钟/天；对照组：增加 84.50±149.23 分钟/天；d=0.79）。与对照组相比，ADSTEP 在 3 个月随访时对行走时间的影响为中等（P>.05，ADSTEP：117.53±148.40 分钟/天；对照组：46.43±58.55 分钟/天；d=0.63）。
ADSTEP 可预防跌倒、减少坐姿时间，并且可能增加 PwMS 的行走时间。
