Department of Physical Medicine and Rehabilitation, University of Kentucky, 2050 Versailles Road, Lexington, KY, 40504, USA.
Department of Mechanical Engineering, University of Kentucky, 2050 Versailles Road, Lexington, KY, 40504, USA.
J Neuroeng Rehabil. 2020 Nov 30;17(1):157. doi: 10.1186/s12984-020-00791-2.
Dynamic body-weight support (DBWS) may play an important role in rehabilitation outcomes, but the potential benefit among disease-specific populations is unclear. In this study, we hypothesize that overground therapy with DBWS during inpatient rehabilitation yields greater functional improvement than standard-of-care in adults with non-traumatic spinal cord injury (NT-SCI).
This retrospective cohort study included individuals diagnosed with NT-SCI and undergoing inpatient rehabilitation. All participants were recruited at a freestanding inpatient rehabilitation hospital. Individuals who trained with DBWS for at least three sessions were allocated to the experimental group. Participants in the historical control group received standard-of-care (i.e., no DBWS). The primary outcome was change in the Functional Independence Measure scores (FIM).
During an inpatient rehabilitation course, participants in the experimental group (n = 11), achieved a mean (SD) FIM of 48 (11) points. For the historical control group (n = 11), participants achieved a mean (SD) FIM of 36 (12) points. From admission to discharge, both groups demonstrated a statistically significant FIM. Between groups analysis revealed no significant difference in FIM (p = 0.022; 95% CI 2.0-22) after a post hoc correction for multiple comparisons. In a secondary subscore analysis, the experimental group achieved significantly higher gains in sphincter control (p = 0.011: 95% CI 0.83-5.72) with a large effect size (Cohen's d 1.19). Locomotion subscores were not significantly different (p = 0.026; 95% CI 0.37-5.3) nor were the remaining subscores in self-care, mobility, cognition, and social cognition.
This is the first study to explore the impact of overground therapy with DBWS on inpatient rehabilitation outcomes for persons with NT-SCI. Overground therapy with DBWS appears to significantly improve functional gains in sphincter control compared to the standard-of-care. Gains achieved in locomotion, mobility, cognition, and social cognition did not meet significance. Findings from the present study will benefit from future large prospective and randomized studies.
动态体重支持（DBWS）可能在康复结果中发挥重要作用，但在特定疾病人群中的潜在益处尚不清楚。在这项研究中，我们假设在非创伤性脊髓损伤（NT-SCI）成人的住院康复期间，与常规护理相比，使用 DBWS 进行地面治疗可带来更大的功能改善。
这是一项回顾性队列研究，纳入了诊断为 NT-SCI 并接受住院康复治疗的患者。所有参与者均在一家独立的住院康复医院招募。接受至少 3 次 DBWS 训练的患者被分配到实验组。历史对照组的参与者接受常规护理（即无 DBWS）。主要结局是功能性独立性测量（FIM）评分的变化。
在住院康复期间，实验组（n=11）的患者平均（SD）FIM 为 48（11）分。历史对照组（n=11）的患者平均（SD）FIM 为 36（12）分。两组患者从入院到出院均表现出 FIM 的统计学显著改善。组间分析显示，在进行多次比较的事后校正后，FIM 无显著差异（p=0.022；95%CI 2.0-22）。在次要亚评分分析中，实验组在括约肌控制方面取得了显著更高的改善（p=0.011：95%CI 0.83-5.72），具有较大的效应量（Cohen's d 1.19）。运动亚评分无显著差异（p=0.026；95%CI 0.37-5.3），自理、移动、认知和社会认知的其余亚评分也无显著差异。
这是第一项探索 NT-SCI 患者使用地面 DBWS 治疗对住院康复结果影响的研究。与常规护理相比，DBWS 地面治疗似乎可显著改善括约肌控制方面的功能改善。在运动、移动、认知和社会认知方面的改善未达到显著性。本研究的结果将受益于未来的大型前瞻性和随机研究。
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