Jee Sanghyun, Jang Chan Woong, Shin Sang Hoon, Kim Yeji, Park Jung Hyun
Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea.
Front Med (Lausanne). 2024 Oct 23;11:1450883. doi: 10.3389/fmed.2024.1450883. eCollection 2024.
Early rehabilitation post-spinal surgery is vital for patients' recovery. Robot-assisted gait training (RAGT) shows promise but requires further study to establish a specific protocol and gauge its effects on both patients and physical therapists. This study aimed to determine the impact of a newly developed protocol for early RAGT on patients' functional enhancement and satisfaction levels after spinal surgery, as well as on the physical therapists who implemented the therapy.
First, we developed the protocol in collaboration with three physiatrists and two physical therapists with extensive experience in musculoskeletal rehabilitation. The protocol was updated three times, each after three rounds of face-to-face meetings. Afterward, we conducted a cross-sectional study involving five physical therapists and 32 post-spinal surgery patients at a tertiary hospital rehabilitation center. The intervention consisted of five sessions of RAGT. Main outcome measures included the Functional Ambulation Category (FAC), the ambulation item of the Modified Barthel Index (MBI ambulation), and satisfaction surveys for both patients and physical therapists.
RAGT typically started 17.91 ± 9.76 days postoperatively and was successfully applied with no remarkable adverse effects. The FAC scores increased from 2.65 ± 1.21 to 3.78 ± 0.71 = 0.006), and MBI ambulation increased from 7.69 ± 2.71 to 10.66 ± 2.90 ( < 0.001) between transfer and discharge. Satisfaction with the robot, RAGT, and treatment, assessed using a 5-point Likert scale, were 3.30 ± 0.79, 3.72 ± 0.85, and 3.08 ± 0.84, respectively. Satisfaction was notably the highest for alleviating fear of falling, whereas managing pain and discomfort during position changes scored the lowest. Physical therapists rated RAGT satisfaction, impact on the working environment, and treatment stability at 3.0 ± 0.65, 2.80 ± 0.67, and 3.50 ± 0.61, respectively.
Early spinal surgery rehabilitation with RAGT improved patients' functionality and gait satisfaction. While physical therapists considered RAGT safe, its impact on their work environment was limited. Integrating RAGT into post-spinal surgery rehabilitation demands ongoing protocol refinement, custom robot development, and efficacy evaluations.
脊柱手术后的早期康复对患者的恢复至关重要。机器人辅助步态训练（RAGT）显示出前景，但需要进一步研究以建立特定方案并评估其对患者和物理治疗师的影响。本研究旨在确定新开发的早期RAGT方案对脊柱手术后患者功能增强和满意度水平的影响，以及对实施该治疗的物理治疗师的影响。
首先，我们与三位物理医学与康复专家和两位在肌肉骨骼康复方面经验丰富的物理治疗师合作制定了该方案。该方案经过三轮面对面会议后进行了三次更新。之后，我们在一家三级医院康复中心对五名物理治疗师和32名脊柱手术后患者进行了横断面研究。干预包括五节RAGT课程。主要结局指标包括功能步行分类（FAC）、改良Barthel指数的步行项目（MBI步行）以及患者和物理治疗师的满意度调查。
RAGT通常在术后17.91±9.76天开始，且成功应用，未出现明显不良反应。在转院和出院之间，FAC评分从2.65±1.21提高到3.78±0.71（ = 0.006），MBI步行从7.69±2.71提高到10.66±2.90（ < 0.001）。使用5点李克特量表评估，对机器人、RAGT和治疗的满意度分别为3.30±0.79、3.72±0.85和3.08±0.84。缓解跌倒恐惧的满意度尤其最高，而在体位改变期间管理疼痛和不适的满意度得分最低。物理治疗师对RAGT满意度、对工作环境的影响和治疗稳定性的评分分别为3.0±0.65、2.80±0.67和3.50±0.61。
采用RAGT进行脊柱手术早期康复可改善患者功能和步态满意度。虽然物理治疗师认为RAGT安全，但其对工作环境的影响有限。将RAGT纳入脊柱手术后康复需要持续完善方案、定制机器人开发和疗效评估。
