Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Payathai, Ratchathewi, Bangkok, 10400, Thailand.
Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.
J Orthop Surg Res. 2023 Jan 23;18(1):60. doi: 10.1186/s13018-022-03459-w.
Recent pieces of evidence about the efficacy of gait rehabilitation for incomplete spinal cord injury remain unclear. We aimed to estimate the treatment effect and find the best gait rehabilitation to regain velocity, distance, and Walking Index Spinal Cord Injury (WISCI) among incomplete spinal cord injury patients.
PubMed and Scopus databases were searched from inception to October 2022. Randomized controlled trials (RCTs) were included in comparison with any of the following: conventional physical therapy, treadmill, functional electrical stimulation and robotic-assisted gait training, and reported at least one outcome. Two reviewers independently selected the studies and extracted the data. Meta-analysis was performed using random-effects or fixed-effect model according to the heterogeneity. Network meta-analysis (NMA) was indirectly compared with all interventions and reported as pooled unstandardized mean difference (USMD) and 95% confidence interval (CI). Surface under the cumulative ranking curve (SUCRA) was calculated to identify the best intervention.
We included 17 RCTs (709 participants) with the mean age of 43.9 years. Acute-phase robotic-assisted gait training significantly improved the velocity (USMD 0.1 m/s, 95% CI 0.05, 0.14), distance (USMD 64.75 m, 95% CI 27.24, 102.27), and WISCI (USMD 3.28, 95% CI 0.12, 6.45) compared to conventional physical therapy. In NMA, functional electrical stimulation had the highest probability of being the best intervention for velocity (66.6%, SUCRA 82.1) and distance (39.7%, SUCRA 67.4), followed by treadmill, functional electrical stimulation plus treadmill, robotic-assisted gait training, and conventional physical therapy, respectively.
Functional electrical stimulation seems to be the best treatment to improve walking velocity and distance for incomplete spinal cord injury patients. However, a large-scale RCT is required to study the adverse events of these interventions.
PROSPERO number CRD42019145797.
最近有一些关于步态康复对不完全性脊髓损伤疗效的证据，但仍不清楚。我们旨在评估治疗效果，并找到恢复不完全性脊髓损伤患者速度、距离和脊髓损伤步行指数（WISCI）的最佳步态康复方法。
从建库至 2022 年 10 月，我们检索了 PubMed 和 Scopus 数据库。纳入了与以下任何一种方法进行比较的随机对照试验（RCT）：常规物理疗法、跑步机、功能性电刺激和机器人辅助步态训练，并报告了至少一个结局。两名审查员独立选择研究并提取数据。根据异质性，采用随机效应或固定效应模型进行荟萃分析。网络荟萃分析（NMA）对所有干预措施进行间接比较，并报告为汇总未标准化均数差（USMD）和 95%置信区间（CI）。计算累积排序曲线下面积（SUCRA）以确定最佳干预措施。
我们纳入了 17 项 RCT（709 名参与者），平均年龄为 43.9 岁。急性期机器人辅助步态训练与常规物理疗法相比，显著提高了速度（USMD 0.1 m/s，95%CI 0.05，0.14）、距离（USMD 64.75 m，95%CI 27.24，102.27）和 WISCI（USMD 3.28，95%CI 0.12，0.65）。在 NMA 中，功能性电刺激在速度（66.6%，SUCRA 82.1）和距离（39.7%，SUCRA 67.4）方面最有可能成为最佳干预措施，其次是跑步机、功能性电刺激加跑步机、机器人辅助步态训练和常规物理疗法。
功能性电刺激似乎是改善不完全性脊髓损伤患者步行速度和距离的最佳治疗方法。然而，需要进行大规模 RCT 来研究这些干预措施的不良事件。
PROSPERO 编号 CRD42019145797。
