Aerobic treadmill plus Bobath walking training improves walking in subacute stroke: a randomized controlled trial
Aerobic treadmill plus Bobath walking training improves walking in subacute stroke: a randomized controlled trial
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DOI：
10.1191/0269215504cr779oa
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发表时间：
2004-09-01
影响因子：
3
通讯作者：
Hesse, S
中科院分区：
文献类型：
--
作者：
Eich, HJ;Mach, H;Hesse, S
目的：评价有氧跑步机加Bobath步行训练与单独进行Bobath步行训练相比对亚急性脑卒中幸存者的近期和长期影响。设计：随机对照试验。单位：康复病房。受试者：50例患者，首次幕上卒中，卒中间隔小于6周，Barthel指数（0-100）在50 - 80之间，能够在间歇帮助或站立时行走至少12米，心血管稳定，自行车几何测量最小50 W，随机分为a组和b组。A组：每个工作日进行30分钟的跑步机训练，根据患者需要固定背带并进行最低限度的支撑，同时进行30分钟的物理治疗，持续6周，调整跑步机的速度和倾斜度，使心率达到HR:(Hrmax-HRrest)*0.6+HRrest；B组每日物理治疗60分钟，连续6周。主要结局指标：主要结局变量是行走速度（m/s）和行走能力(m)的绝对改善，次要结局变量是大运动功能，包括行走能力（得分为13分）和行走质量（得分为41分），在干预前后和三个月后随访时进行盲测。结果：实验组患者对有氧训练耐受良好，无副作用，在研究结束时（p = 0.001对p = 0.002）和随访时（p < 0.001对p < 0.001），步行速度和步行能力的改善均显著大于对照组。在第0周到第6周之间，实验组的步行速度和能力平均提高了。31 m/s和91 m，对照组平均0.16 m/s和56 m。从第0周到第18周，实验组的步行速度和步行能力平均提高了0.36 m/s和111 m，对照组的步行速度和步行能力平均提高了0.15 m/s和57 m。大运动功能和行走质量在任何时候都没有差异。结论：有氧跑步机加Bobath步行训练对中度脑卒中患者行走速度和行走能力的改善优于单独进行Bobath步行训练。在符合纳入标准的患者中推荐采用该治疗方法。接下来应该进行多中心试验以加强证据。
Objective: To evaluate the immediate and long-term effects of aerobic treadmill plus Bobath walking training in subacute stroke survivors compared with Bobath walking training alone.Design: Randomized controlled trial.Setting: Rehabilitation unit.Subjects: Fifty patients, first-time supratentorial stroke, stroke interval less than six weeks, Barthel Index (0-100) from 50 to 80, able to walk a minimum distance of 12 m with either intermittent help or stand-by while walking, cardiovascular stable, minimum 50 W in the bicycle ergometry, randomly allocated to two groups, A and B.Interventions: Group A 30 min of treadmill training, harness secured and minimally supported according to patients' needs, and 30 min of physiotherapy, every workday for six weeks, speed and inclination of the treadmill were adjusted to achieve a heart rate of HR: (Hrmax-HRrest)*0.6+HRrest; in group B 60 min of daily physiotherapy for six weeks.Main outcome measures: Primary outcome variables were the absolute improvement of walking velocity (m/s) and capacity ( m), secondary were gross motor function including walking ability ( score out of 13) and walking quality ( score out of 41), blindly assessed before and after the intervention, and at follow-up three months later.Results: Patients tolerated the aerobic training well with no side-effects, significantly greater improvement of walking velocity and capacity both at study end (p = 0.001 versus p = 0.002) and at follow-up (p < 0.001 versus p < 0.001) in the experimental group. Between weeks 0 and 6, the experimental group improved walking speed and capacity by a mean of .31 m/s and 91 m, the control group by a mean of 0.16 m/s and 56 m. Between weeks 0 and 18, the experimental group improved walking speed and capacity by a mean of 0.36 m/s and 111 m, the control group by a mean of 0.15 m/s and 57 m. Gross motor function and walking quality did not differ at any time.Conclusions: Aerobic treadmill plus Bobath walking training in moderately affected stroke patients was better than Bobath walking training alone with respect to the improvement of walking velocity and capacity. The treatment approach is recommended in patients meeting the inclusion criteria. A multicentre trial should follow to strengthen the evidence.