动力假肢对使用者观点、新陈代谢和活动的影响：一项随机交叉试验。
The influence of powered prostheses on user perspectives, metabolics, and activity: a randomized crossover trial.
机构信息
School of Kinesiology, University of Michigan, 401 Washtenaw Avenue, Ann Arbor, MI, 48109-2214, USA.
Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA.
出版信息
J Neuroeng Rehabil. 2021 Mar 16;18(1):49. doi: 10.1186/s12984-021-00842-2.
BACKGROUND
Powered prosthetic ankles provide battery-powered mechanical push-off, with the aim of reducing the metabolic demands of walking for people with transtibial amputations. The efficacy of powered ankles has been shown in active, high functioning individuals with transtibial amputation, but is less clear in other populations. Additionally, it is unclear how use of a powered prosthesis influences everyday physical activity and mobility.
METHODS
Individuals with unilateral transtibial amputations participated in a randomized clinical trial comparing their prescribed, unpowered prosthesis and the BiOM powered prosthesis. Participants' metabolic costs and self-selected walking speeds were measured in the laboratory and daily step count, daily steps away from home, and walking speed were measured over two weeks of at-home prosthesis use. Participants also rated their perception of mobility and quality of life and provided free-form feedback. Dependent measures were compared between prostheses and the relationships between metabolic cost, perception of mobility, and characteristics of walking in daily life were explored using Pearson's correlations.
RESULTS
Twelve people were randomly allocated to the powered prosthesis first (n = 7) or unpowered prosthesis first (n = 5) and ten completed the full study. There were no differences in metabolic costs (p = 0.585), daily step count (p = 0.995), walking speed in-lab (p = 0.145) and in daily life (p = 0.226), or perception of mobility between prostheses (p ≥ 0.058). Changes varied across participants, however. There were several medium-sized effects for device comparisons. With the powered prosthesis, participants had increased self-reported ambulation (g = 0.682) and decreased frustration (g = 0.506).
CONCLUSIONS
There were no universal benefits of the powered prosthesis on function in the lab or home environment. However, the effects were subject-specific, with some reporting preference for power and improved mobility, and some increasing their activity and decreasing their metabolic effort. Additionally, self-reported preferences did not often correlate with objective measures of function. This highlights the need for future clinical research to include both perception and objective measures to better inform prosthetic prescription.
TRIAL REGISTRATION
https://clinicaltrials.gov , #NCT02828982. Registered 12 July 2016, https://clinicaltrials.gov/ct2/show/NCT02828982.
背景
动力假肢提供电池驱动的机械推进，目的是降低小腿截肢者行走的代谢需求。动力踝关节已在活动能力强的小腿截肢者中显示出疗效，但在其他人群中的效果尚不清楚。此外，使用动力假肢如何影响日常身体活动和移动性也不清楚。
方法
单侧小腿截肢者参加了一项随机临床试验，比较了他们规定的非动力假肢和 BiOM 动力假肢。参与者在实验室测量代谢成本和自我选择的行走速度，并在两周的家庭假肢使用期间测量日常步数、离家日常步数和行走速度。参与者还对他们的移动感知和生活质量进行了评分，并提供了自由格式的反馈。使用 Pearson 相关系数探讨了依赖措施在假肢之间的差异以及代谢成本、移动感知与日常生活中行走特征之间的关系。
结果
12 人被随机分配到先使用动力假肢（n=7）或非动力假肢（n=5），其中 10 人完成了完整的研究。两种假肢之间在代谢成本（p=0.585）、日常步数（p=0.995）、实验室行走速度（p=0.145）和日常生活中的行走速度（p=0.226）以及移动感知方面均无差异（p≥0.058）。然而，变化因参与者而异。设备比较有几个中等大小的效果。使用动力假肢，参与者自我报告的步行能力提高（g=0.682），挫败感降低（g=0.506）。
结论
动力假肢在实验室或家庭环境中对功能没有普遍益处。然而，效果是针对个体的，有些报告更喜欢动力和更好的移动性，有些则增加了活动量，减少了代谢消耗。此外，自我报告的偏好并不总是与功能的客观测量相关。这凸显了未来临床研究需要同时包括感知和客观测量，以更好地为假肢处方提供信息。
试验注册
https://clinicaltrials.gov，#NCT02828982。2016 年 7 月 12 日注册，https://clinicaltrials.gov/ct2/show/NCT02828982。
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