The evolution of walking-related outcomes over the first 12 weeks of rehabilitation for incomplete traumatic spinal cord injury: The multicenter randomized Spinal Cord Injury Locomotor Trial
The evolution of walking-related outcomes over the first 12 weeks of rehabilitation for incomplete traumatic spinal cord injury: The multicenter randomized Spinal Cord Injury Locomotor Trial
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DOI：
10.1177/1545968306295556
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发表时间：
2007-01-01
影响因子：
4.2
通讯作者：
Scott, M.
中科院分区：
文献类型：
--
作者：
Dobkin, B.;Barbeau, H.;Scott, M.
背景脊髓损伤运动试验（SCILT）比较了12周的跑步机上的步行训练和体重支持（BWSTT），其中包括地面练习，以定义但更传统的地面移动干预（CONT），用于发病8周内的不完全创伤性SCI患者。以前的研究没有报道康复期间与行走相关的结果。方法.这项单盲、随机试验入组了107名美国脊柱损伤协会（ASIA）C和D级患者和38名ASIA B级患者，这些患者的病变位于C5和L3之间，入院时无法行走进行康复。每2周收集一次步行功能独立性测量（FIM-L）、15 m步行速度和下肢运动评分（LEMS）。结果在入组时和治疗期间未发现显著差异（12周平均FIM-L = 5，速度= 0.8 m/s，LEMS = 35，6分钟步行距离= 250 m）。结合两组，< 10%的ASIA B组患者、92%的ASIA C组患者和所有ASIA D组患者的FIM-L >= 4。步行速度>= 0.6 m/s与LEMS接近40或更高相关。结论.在12周BWSTT和CONT治疗结束时，少数ASIA B和大多数ASIA C和D患者实现了功能性行走能力，与6个月时的主要结局数据一致。每隔2周评估一次行走相关指标，结果显示SCI后的时间是患者进入试验的一个重要变量。在进入后约6周，大多数将恢复的患者的FIM-L已改善至>3，并且步行速度正在改善。未来的试验可能会减少需要治疗的患者数量，如果ASIA分级< 4 at >仍为≥ 12周，如果ASIA分级仍为C，则在发病后8周入组FIM-L患者。
Background. The Spinal Cord Injury Locomotor Trial (SCILT) compared 12 weeks of step training with body weight support on a treadmill (BWSTT) that included overground practice to a defined but more conventional overground mobility intervention (CONT) in patients with incomplete traumatic SCI within 8 weeks of onset. No previous studies have reported walking-related outcomes during rehabilitation. Methods. This single-blinded, randomized trial entered 107 American Spinal Injury Association (ASIA) C and D patients and 38 ASIA B patients with lesions between C5 and L3 who were unable to walk on admission for rehabilitation. The Functional Independence Measure (FIM-L) for walking, 15-m walking speed, and lower extremity motor score (LEMS) were collected every 2 weeks. Results. No significant differences were found at entry and during the treatment phase (12-week mean FIM-L = 5, velocity = 0.8 m/s, LEMS = 35, distance walked in 6 min = 250 m). Combining the 2 arms, a FIM-L >= 4 was achieved in < 10% of ASIA B patients, 92% of ASIA C patients, and all of ASIA D patients. Walking speed of >= 0.6 m/s correlated with a LEMS near 40 or higher. Conclusions. Few ASIA B and most ASIA C and D patients achieved functional walking ability by the end of 12 weeks of BWSTT and CONT, consistent with the primary outcome data at 6 months. Walking-related measures assessed at 2-week intervals reveal that time after SCI is an important variable for entering patients into a trial with mobility outcomes. By about 6 weeks after entry, most patients who will recover have improved their FIM-L to >3 and are improving in walking speed. Future trials may reduce the number needed to treat by entering patients with FIM-L < 4 at > 8 weeks after onset if still graded ASIA Band at > 12 weeks if still ASIA C.