Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
Department of Biomechanical Engineering, Technical University of Delft, Delft, The Netherlands.
PLoS One. 2024 Jul 11;19(7):e0305564. doi: 10.1371/journal.pone.0305564. eCollection 2024.
People fall more often when their gait stability is reduced. Gait stability can be directly manipulated by exerting forces or moments onto a person, ranging from simple walking sticks to complex wearable robotics. A systematic review of the literature was performed to determine: What is the level of evidence for different types of mechanical manipulations on improving gait stability? The study was registered at PROSPERO (CRD42020180631). Databases Embase, Medline All, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and Google Scholar were searched. The final search was conducted on the 1st of December, 2022. The included studies contained mechanical devices that influence gait stability for both impaired and non-impaired subjects. Studies performed with prosthetic devices, passive orthoses, and analysing post-training effects were excluded. An adapted NIH quality assessment tool was used to assess the study quality and risk of bias. Studies were grouped based on the type of device, point of application, and direction of forces and moments. For each device type, a best-evidence synthesis was performed to quantify the level of evidence based on the type of validity of the reported outcome measures and the study quality assessment score. Impaired and non-impaired study participants were considered separately. From a total of 4701 papers, 53 were included in our analysis. For impaired subjects, indicative evidence was found for medio-lateral pelvis stabilisation for improving gait stability, while limited evidence was found for hip joint assistance and canes. For non-impaired subjects, moderate evidence was found for medio-lateral pelvis stabilisation and limited evidence for body weight support. For all other device types, either indicative or insufficient evidence was found for improving gait stability. Our findings also highlight the lack of consensus on outcome measures amongst studies of devices focused on manipulating gait.
人们在步态稳定性降低时更容易摔倒。可以通过向人施加力或力矩来直接操纵步态稳定性，范围从简单的拐杖到复杂的可穿戴机器人。对文献进行了系统回顾，以确定：不同类型的机械操作对改善步态稳定性的证据水平如何？该研究在 PROSPERO（CRD42020180631）上进行了注册。搜索了 Embase、Medline All、Web of Science Core Collection、Cochrane Central Register of Controlled Trials 和 Google Scholar 数据库。最后一次搜索是在 2022 年 12 月 1 日进行的。纳入的研究包含了影响受损和非受损受试者步态稳定性的机械装置。排除了使用假肢装置、被动矫形器和分析训练后效果的研究。使用改良的 NIH 质量评估工具评估研究质量和偏倚风险。根据装置类型、应用点以及力和力矩的方向对研究进行分组。对于每种装置类型，都进行了最佳证据综合，根据报告的结果测量的有效性类型和研究质量评估评分来量化证据水平。分别考虑了受损和非受损的研究参与者。从总共 4701 篇论文中，有 53 篇被纳入我们的分析。对于受损的受试者，有证据表明骨盆的横向稳定可以改善步态稳定性，而髋关节辅助和拐杖的证据有限。对于非受损的受试者，骨盆的横向稳定有中等证据，而身体重量支持的证据有限。对于所有其他装置类型，改善步态稳定性的证据要么是指示性的，要么是不足的。我们的研究结果还强调了在专注于操纵步态的设备研究中，对结果测量缺乏共识。
