Department of Rehabilitation Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.
Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands.
PLoS One. 2023 Jan 18;18(1):e0279292. doi: 10.1371/journal.pone.0279292. eCollection 2023.
Lower limb orthoses intend to improve walking in adults with neuromuscular disorders (NMD). Yet, reported group effects of lower limb orthoses on treatment outcomes have generally been small and heterogeneous. We propose that guideline-based orthotic care within a multidisciplinary expert setting may improve treatment outcomes.
To examine the effectiveness of specialist care orthoses compared to usual care orthoses on personal goal attainment and walking ability.
Cohort study.
Adults with NMD who experienced walking problems due to calf and/or quadriceps muscle weakness and were provided with a specialist care lower limb orthosis between October 2011 and January 2021.
Three months after provision, the specialist care orthosis was compared to the usual care orthosis worn at baseline in terms of personal goal attainment (Goal Attainment Scaling (GAS)), comfortable walking speed (m/s), net energy cost (J/kg/m) (both assessed during a 6-minute walk test), perceived walking ability and satisfaction.
Sixty-four adults with NMD were eligible for analysis. The specialist care orthoses comprised 19 dorsiflexion-restricting ankle-foot orthoses (AFOs), 22 stance-control knee-ankle-foot orthoses (KAFOs) and 23 locked KAFOs. Overall, 61% of subjects showed a clinically relevant improvement in GAS score. Perceived safety, stability, intensity, fear of falling and satisfaction while walking all improved (p≤0.002), and subjects were satisfied with their specialist care orthosis and the services provided. Although no effects on walking speed or net energy cost were found in combined orthosis groups, specialist care AFOs significantly reduced net energy cost (by 9.5%) compared to usual care orthoses (from mean (SD) 3.81 (0.97) to 3.45 (0.80) J/kg/m, p = 0.004).
Guideline-based orthotic care within a multidisciplinary expertise setting could improve treatment outcomes in adults with NMD compared to usual orthotic care by improvements in goal attainment and walking ability. A randomized controlled trial is now warranted to confirm these results.
下肢矫形器旨在改善患有神经肌肉疾病（NMD）的成年人的行走能力。然而，报告的下肢矫形器对治疗结果的总体影响较小且具有异质性。我们提出，在多学科专家环境中基于指南的矫形器护理可能会改善治疗结果。
研究专科护理矫形器与常规护理矫形器在个人目标实现和行走能力方面的效果。
队列研究。
2011 年 10 月至 2021 年 1 月期间，因小腿和/或四头肌无力而出现行走问题并配备了专科护理下肢矫形器的 NMD 成年人。
在提供矫形器后 3 个月，专科护理矫形器与基线时佩戴的常规护理矫形器在个人目标实现（目标实现量表（GAS））、舒适行走速度（m/s）、净能量消耗（J/kg/m）（均在 6 分钟步行测试中评估）、感知行走能力和满意度方面进行比较。
64 名患有 NMD 的成年人符合分析条件。专科护理矫形器包括 19 个背屈限制踝足矫形器（AFO）、22 个站立控制膝踝足矫形器（KAFO）和 23 个锁定 KAFO。总体而言，61%的受试者 GAS 评分有临床相关的改善。感知安全性、稳定性、强度、跌倒恐惧和行走满意度均得到改善（p≤0.002），并且受试者对专科护理矫形器和所提供的服务感到满意。尽管联合矫形器组在行走速度或净能量消耗方面未发现任何影响，但专科护理 AFO 与常规护理矫形器相比，净能量消耗显著降低（从平均（SD）3.81（0.97）降至 3.45（0.80）J/kg/m，p=0.004）。
与常规矫形器护理相比，在多学科专业知识环境中基于指南的矫形器护理可能通过改善目标实现和行走能力来改善 NMD 成年人的治疗结果。现在需要进行一项随机对照试验来证实这些结果。
