多发性硬化症患者在 6 分钟步行试验期间和之后的步态特征变化：系统评价。
Changes in Gait Characteristics During and Immediately After the 6-Minute Walk Test in Persons With Multiple Sclerosis: A Systematic Review.
机构信息
REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium.
Graduate School of Health Sciences Dokuz Eylül University, Izmir, Turkey.
出版信息
Phys Ther. 2022 Jul 4;102(7). doi: 10.1093/ptj/pzac036.
OBJECTIVE
There is limited information about gait patterns during prolonged walking in people with multiple sclerosis (PwMS). The aim of this review was to report on gait metrics during and immediately after the 6-Minute Walk Test (6MWT) in PwMS with different levels of disability.
METHODS
The systematic search was performed in 3 databases (PubMed, Web of Science, and SCOPUS) using keywords related to multiple sclerosis and 6MWT. Studies that reported on quantitative gait outcomes before and after the 6MWT or multiple time points during the 6MWT were included. The Hedges g effect size (ES) was calculated to determine the magnitude of change in each gait parameter.
RESULTS
Fourteen studies (n = 534 PwMS; n = 166 healthy controls) were eligible. Five studies investigated gait parameters prior to and immediately after the 6MWT. Nine studies collected gait measures during the 6MWT. Speed (ES = -0.43 to 0.19), cadence (ES = -0.46 to 0.16), step length (ES = -0.46 to 0.14), stability (ES = -0.35 to 0.33), and regularity (ES = -0.25 to -0.15) decreased in most studies. In the majority of included studies, step time (ES = 0 to 0.35), stance period (ES = 0.12 to 0.58), double support phase (ES = 0.03 to 0.62), variability (ES = -0.19 to 1.13), and asymmetry (ES = -0.79 to 0.62) increased following the 6MWT. The kinetic and kinematic (mainly in dorsiflexion angle [ES = -0.08 to -0.36]) features of gait were also negatively changed after 6 minutes of walking. Walking speed, cadence, step length, stride length, and stride time after 6MWT at a comfortable speed all increased. Changes in the majority of spatiotemporal parameters were more pronounced in PwMS with moderate-to-severe disability compared with PwMS with mild disability.
CONCLUSION
Most quantitative gait parameters deteriorated during the 6MWT, especially in PwMS with moderate-to-severe disability.
IMPACT
The deterioration of gait patterns should be considered when designing therapeutic interventions to increase sustained walking capacity.
目的
关于多发性硬化症（MS）患者长时间行走时的步态模式，相关信息有限。本综述旨在报告不同残疾程度的 MS 患者在 6 分钟步行测试（6MWT）期间和之后的步态测量值。
方法
在 3 个数据库（PubMed、Web of Science 和 SCOPUS）中使用与多发性硬化症和 6MWT 相关的关键词进行系统检索。纳入报告 6MWT 前后或 6MWT 期间多个时间点定量步态结果的研究。使用 Hedge g 效应量（ES）来确定每个步态参数的变化幅度。
结果
有 14 项研究（n=534 名 MS 患者；n=166 名健康对照者）符合纳入标准。其中 5 项研究在 6MWT 前后分别检测了步态参数。9 项研究在 6MWT 期间收集了步态测量值。在大多数研究中，速度（ES=-0.43 至 0.19）、步频（ES=-0.46 至 0.16）、步长（ES=-0.46 至 0.14）、稳定性（ES=-0.35 至 0.33）和规律性（ES=-0.25 至 -0.15）降低。在大多数纳入的研究中，步时（ES=0 至 0.35）、站立期（ES=0.12 至 0.58）、双支撑阶段（ES=0.03 至 0.62）、变异性（ES=-0.19 至 1.13）和不对称性（ES=-0.79 至 0.62）在 6MWT 后增加。6 分钟步行后，步态的动力学和运动学（主要是背屈角度[ES=-0.08 至 -0.36]）特征也发生了负向变化。以舒适速度进行 6MWT 后，步行速度、步频、步长、跨步长和步时均增加。与轻度残疾的 MS 患者相比，中重度残疾的 MS 患者的大多数时空参数变化更为明显。
结论
在 6MWT 期间，大多数定量步态参数恶化，尤其是中重度残疾的 MS 患者。
影响
在设计增加持续行走能力的治疗干预措施时，应考虑步态模式的恶化。
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