机器人辅助步态训练在各种神经疾病患者中的应用：一项混合方法可行性研究。

Robot-assisted gait training in patients with various neurological diseases: A mixed methods feasibility study.

机构信息

Department of Rehabilitation Science, Clinic for Rehabilitation Münster, Münster, Austria.

Department of Neurology, Clinic for Rehabilitation Münster, Münster, Austria.

出版信息

PLoS One. 2024 Aug 27;19(8):e0307434. doi: 10.1371/journal.pone.0307434. eCollection 2024.

DOI:10.1371/journal.pone.0307434

PMID:39190743

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11349200/

Abstract

BACKGROUND

Walking impairment represents a relevant symptom in patients with neurological diseases often compromising social participation. Currently, mixed methods studies on robot-assisted gait training (RAGT) in patients with rare neurological diseases are lacking. This study aimed to explore the feasibility, acceptability, goal attainment and preliminary effects of RAGT in patients with common and rare neurological diseases and understand the intervention context and process.

METHODS

A mixed-methods feasibility study was conducted at an Austrian rehabilitation centre. Twenty-eight inpatients after stroke in the subacute and chronic phases, with multiple sclerosis, Parkinson's disease, spinal cord injury, spinocerebellar ataxia, acute/chronic inflammatory demyelinating polyneuropathy and motor neuron disease were included. Patients received RAGT for 45 minutes, 4x/week, for 4 weeks. Baseline and post-intervention assessments included gait parameters, walking and balance, and questionnaires. Semi-structured observations were conducted twice during the intervention period and analysed using thematic analysis. Descriptive statistics within the respective disease groups and calculation of effect sizes for the total sample were performed. Triangulation was employed to develop a deeper understanding of the research topic.

RESULTS

Data from 26 patients (mean age 61.6 years [standard deviation 13.2]) were analysed. RAGT was highly accepted by patients and feasible, indicated by recruitment, retention, and adherence rates of 84.8% (95% confidence interval, CI 0.7-0.9), 92.2% (95% CI 0.7-1.0) and 94.0% (95% CI 91.4-96.2), respectively. Goal attainment was high, and only mild adverse events occurred. Improvements in walking speed (10-Metre Walk Test, effect size r = 0.876), walking distance (6-Minute Walk Test, r = 0.877), functional mobility (Timed Up and Go, r = 0.875), gait distance (r = 0.829) and number of steps (r = 0.834) were observed. Four themes were identified: familiarising with RAGT; enjoyment and acceptance through a trusting therapeutic relationship; actively interacting; and minimising dissatisfaction.

DISCUSSION

Sufficiently powered randomised controlled trials are needed to validate our results.

TRIAL REGISTRATION

German Clinical Trials Register, DRKS00027887.

摘要

背景

行走障碍是神经系统疾病患者的一种常见症状，常导致社会参与度下降。目前，针对罕见神经疾病患者的机器人辅助步态训练（RAGT）的混合方法研究较为缺乏。本研究旨在探索 RAGT 在常见和罕见神经疾病患者中的可行性、可接受性、目标达成情况和初步效果，并了解干预的背景和过程。

方法

这是一项在奥地利康复中心开展的混合方法可行性研究。共纳入 28 例处于亚急性期和慢性期的脑卒中患者、多发性硬化症患者、帕金森病患者、脊髓损伤患者、脊髓小脑性共济失调患者、急性/慢性炎症性脱髓鞘性多发性神经病患者和运动神经元病患者。这些患者接受了 4 周、每周 4 次、每次 45 分钟的 RAGT。基线和干预后评估包括步态参数、步行和平衡以及问卷调查。在干预期间进行了两次半结构性观察，并使用主题分析进行了分析。对各疾病组内进行了描述性统计分析，并计算了总样本的效应量。采用三角测量法深入了解研究课题。

结果

共分析了 26 例患者（平均年龄 61.6 岁[标准差 13.2]）的数据。RAGT 得到了患者的高度接受和认可，其招募、保留和依从率分别为 84.8%（95%置信区间，CI 0.7-0.9）、92.2%（95%CI 0.7-1.0）和 94.0%（95%CI 91.4-96.2）。目标达成率高，仅发生轻度不良事件。观察到步行速度（10 米步行测试，效应量 r = 0.876）、步行距离（6 分钟步行测试，r = 0.877）、功能性移动性（计时起立行走测试，r = 0.875）、步态距离（r = 0.829）和步数（r = 0.834）的改善。确定了四个主题：熟悉 RAGT；通过信任的治疗关系获得享受和接受；积极互动；以及将不满最小化。