Department of Healthcare, Centre of Expertise - Innovation in Care, PXL University of Applied Sciences and Arts, Guffenslaan 39, 3500, Hasselt, Belgium.
Faculty of Rehabilitation Sciences, REVAL, Hasselt University, Agoralaan, Gebouw A, 3590, Diepenbeek, Belgium.
J Neuroeng Rehabil. 2021 Dec 28;18(1):184. doi: 10.1186/s12984-021-00977-2.
A client-centred task-oriented approach has advantages towards motivation and adherence to therapy in neurorehabilitation, but it is costly to integrate in practice. An intelligent Activity-based Client-centred Training (i-ACT), a low-cost Kinect-based system, was developed which integrates a client-centred and task-oriented approach. The objectives were (1) to investigate the effect of additional i-ACT training on functioning. And (2) to assess whether training with i-ACT resulted in more goal oriented training.
A single-blind randomised controlled trial was performed in 4 Belgian rehabilitation centres with persons with central nervous system deficits. Participants were randomly allocated through an independent website-based code generator using blocked randomisation (n = 4) to an intervention or control group. The intervention group received conventional care and additional training with i-ACT for 3 × 45 min/week during 6 weeks. The control group received solely conventional care. Functional ability and performance, quality of life (QoL), fatigue, trunk movement, and shoulder active range of motion (AROM) were assessed at baseline, after 3 weeks and 6 weeks of training, and 6 weeks after cessation of training. Data were analysed using non-parametric within and between group analysis.
47 persons were randomised and 45 analysed. Both intervention (n = 25) and control (n = 22) group improved over time on functional ability and performance as measured by the Wolf Motor Function Test, Manual Ability Measure-36, and Canadian Occupational Performance Measure, but no major differences were found between the groups on these primary outcome measures. Regarding QoL, fatigue, trunk movement, and shoulder AROM, no significant between group differences were found. High adherence for i-ACT training was found (i.e. 97.92%) and no adverse events, linked to i-ACT, were reported. In the intervention group the amount of trained personal goals (88%) was much higher than in the control group (46%).
Although additional use of i-ACT did not have a statistically significant added value regarding functional outcome over conventional therapy, additional i-ACT training provides more individualised client-centred therapy, and adherence towards i-ACT training is high. A higher intensity of i-ACT training may increase therapy effects, and should be investigated in future research.
ClinicalTrials.gov Identifier NCT02982811. Registered 29 November 2016.
以客户为中心的任务导向方法在神经康复中对动机和治疗依从性具有优势，但在实践中整合起来成本较高。我们开发了一种低成本的基于 Kinect 的智能基于活动的以客户为中心的训练系统（i-ACT），该系统集成了以客户为中心和任务导向的方法。目的是（1）研究额外的 i-ACT 训练对功能的影响。（2）评估使用 i-ACT 进行训练是否会导致更具目标导向的训练。
在比利时的 4 个康复中心进行了一项单盲随机对照试验，参与者为患有中枢神经系统缺陷的患者。参与者通过独立的基于网站的代码生成器随机分配（n=4），通过分组随机化（n=4），分为干预组和对照组。干预组在 6 周内每周接受 3 次，每次 45 分钟的常规护理和 i-ACT 额外训练。对照组仅接受常规护理。在基线、3 周和 6 周训练后以及训练结束后 6 周，评估功能能力和表现、生活质量（QoL）、疲劳、躯干运动和肩部主动活动范围（AROM）。使用非参数组内和组间分析进行数据分析。
共 47 人随机分组，45 人分析。干预组（n=25）和对照组（n=22）的功能能力和表现均随时间改善，这通过 Wolf 运动功能测试、手动能力测量-36 和加拿大职业表现测量来衡量，但两组在这些主要结局测量上没有发现显著差异。在 QoL、疲劳、躯干运动和肩部 AROM 方面，两组之间没有显著的组间差异。i-ACT 训练的高度依从性（即 97.92%）得到了证明，并且没有报告与 i-ACT 相关的不良事件。在干预组中，接受训练的个人目标（88%）的数量明显高于对照组（46%）。
尽管额外使用 i-ACT 在常规治疗的功能结果方面没有统计学上的显著附加价值，但额外的 i-ACT 训练提供了更个性化的以客户为中心的治疗，并且对 i-ACT 训练的依从性很高。更高强度的 i-ACT 训练可能会增加治疗效果，应该在未来的研究中进行调查。
ClinicalTrials.gov 标识符 NCT02982811。注册于 2016 年 11 月 29 日。
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