用弹性矫形服装代替拐杖治疗慢性中风患者 - 对步态和平衡的影响。一系列 N-of-1 试验。

Replacing canes with an elasticated orthotic-garment in chronic stroke patients - The influence on gait and balance. A series of N-of-1 trials.

机构信息

Department of Physiotherapy, Bildungszentrum Gesundheit Basel-Stadt, 4142, Muenchenstein, Switzerland; Caphri School for Public Health and Primary Care Research, Maastricht University, 6200, MD, Maastricht, the Netherlands; Department of Physiotherapy, REHAB, Clinic for Neurorehabilitation and Paraplegiology, Basel, Switzerland; Department of Health, Bern University of Applied Science, Schwarztorstrasse 48, 3007, Bern, Switzerland.

Caphri School for Public Health and Primary Care Research, Maastricht University, 6200, MD, Maastricht, the Netherlands; Department of Anatomy and Embryology, Maastricht University, 6200, MD, Maastricht, the Netherlands.

出版信息

J Bodyw Mov Ther. 2020 Oct;24(4):203-214. doi: 10.1016/j.jbmt.2020.06.006. Epub 2020 Jul 30.

DOI:10.1016/j.jbmt.2020.06.006

PMID:33218513

Abstract

OBJECTIVE

To investigate the effect of replacing canes with an elasticated orthotic-garment on balance and gait-function in chronic stroke survivors.

DESIGN

Experimental, N-of-1 series with a replicated, ABC design with randomised phase duration in a home setting.

PARTICIPANTS

Four cane using chronic stroke survivors (P1-4).

INTERVENTIONS

Phase A (9-12 weeks) cane-walking "as usual" to establish baseline values; Phase B (9-16 weeks) intervention: orthotic-garment worn throughout the day with maximal cane-use reduction; Phase C (9-10 weeks) participant-determined follow-up: either no walking-aid, orthotic-garment or cane.

OUTCOME MEASURES

Primary: Functional-Gait-Assessment (FGA), Secondary: Trunk-sway during walking measured as Total-Angle-Area (TAA°) in frontal and sagittal-planes, both measured weekly.

RESULTS

Visual and statistical analysis of results showed significant improvements in FGA from phase A to B in all participants. Improvement continued in phase C in P2, stabilized in P1 and P4 and deteriorated in P3. A Minimal-Clinical-Important-Difference of 6 points-change was achieved in P2 & P4. Trunk-sway reduced during walking, indicating increased stability, in two participants from phase A to B and in three participants from A to C but no TAA changes were statistically significant. In phase C participant-selected walking-aids were: P1 cane-usage reduced by 25%, P2 independent-walking with no assistive-device, S3 usual cane-usage, P4 orthotic-garment with reduced cane-usage 2-3 days-a-week, usual cane-usage 4-5 days.

CONCLUSIONS

Although walking ability is multifactorial these results indicate that the choice of walking-aids can have a specific and clinically relevant impact on gait following stroke. "Hands-free" assistive-devices may be more effective than canes in improving gait-function in some patients. CLINICALTRIALS.

GOV ID

NCT03642444.

摘要

目的

探讨用弹性矫形服装代替手杖对慢性脑卒中幸存者平衡和步态功能的影响。

设计

在家庭环境中进行的实验性、N-of-1 系列研究，采用复制的 ABC 设计，随机分相持续时间。

参与者

四名使用手杖的慢性脑卒中幸存者（P1-4）。

干预措施

第 A 期（9-12 周）使用手杖“照常”行走以建立基线值；第 B 期（9-16 周）干预：全天穿着矫形服装，最大程度减少手杖使用；第 C 期（9-10 周）由参与者决定的随访：不使用助行器、矫形服装或手杖。

结果测量

主要：功能性步态评估（FGA），次要：矢状面和额状面总角度面积（TAA°）来测量行走时的躯干摆动，每周测量一次。

结果

所有参与者的 FGA 在 A 期到 B 期都有显著改善。在 P2 参与者中，在 C 期持续改善，在 P1 和 P4 参与者中稳定，在 P3 参与者中恶化。P2 和 P4 参与者的 FGA 变化达到了 6 分的最小临床重要差异。在 A 期到 B 期，有两名参与者和 A 期到 C 期，有三名参与者的行走时躯干摆动减少，表明稳定性增加，但 TAA 变化没有统计学意义。在 C 期，参与者选择的助行器为：P1 手杖使用率降低 25%，P2 独立行走，不使用辅助设备，P3 照常使用手杖，P4 每周 2-3 天使用矫形服装，4-5 天照常使用手杖。