International Randomized Clinical Trial, Stroke Inpatient Rehabilitation With Reinforcement of Walking Speed (SIRROWS), Improves Outcomes
International Randomized Clinical Trial, Stroke Inpatient Rehabilitation With Reinforcement of Walking Speed (SIRROWS), Improves Outcomes
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DOI：
10.1177/1545968309357558
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发表时间：
2010-03-01
影响因子：
4.2
通讯作者：
Lee, Jihey
中科院分区：
文献类型：
--
作者：
Dobkin, Bruce H.;Plummer-D'Amato, Prudence;Lee, Jihey
背景。对表现的反馈可以优化中风后的运动再学习。目标。开展国际合作，使用不需要研究资金的方案，快速测试中风后住院康复期间每日口头反馈步行速度的潜在功效。方法。这项2期、单盲、多中心试验将住院患者随机分为两组，一组在单次每日10米步行后立即反馈自我选择的快速步行速度（每日加强速度，DRS），另一组在常规物理治疗的背景下，在步行后不反馈速度（NRS）。主要结果是出院时15.2米（50英尺）定时行走的速度。次要指标为3分钟内步行距离、住院时间（LOS）和独立程度（功能活动分类，FAC）。结果。在18个月内，179名参与者被随机分配。这些组根据年龄、性别、中风发作到进入的时间、初始速度和行走相关残疾的程度进行平衡。DRS组的放电步行速度（0.91 m/s）高于NRS组（0.72 m/s） （P = 0.01）。LOS没有发现差异。然而，对于那些在进入时平均步行速度为0.4 m/s的人来说，DRS和NRS的LOS都明显较短。DRS组没有更高比例的FAC独立步行者（P = 0.1），也没有走更长的距离（P = 0.09）。结论。一项由18个中心组成的基于互联网的合作发现，每天一次关于表现的反馈可以使步行速度大大提高，足以在住院康复出院时允许无限制的、缓慢的社区步行。
Background. Feedback about performance may optimize motor relearning after stroke. Objectives. Develop an international collaboration to rapidly test the potential efficacy of daily verbal feedback about walking speed during inpatient rehabilitation after stroke, using a protocol that requires no research funds. Methods. This phase 2, single-blinded, multicenter trial randomized inpatients to either feedback about self-selected fast walking speed (daily reinforcement of speed, DRS) immediately after a single, daily 10-m walk or to no reinforcement of speed (NRS) after the walk, performed within the context of routine physical therapy. The primary outcome was velocity for a 15.2-m (50-foot) timed walk at discharge. Secondary outcomes were walking distance in 3 minutes, length of stay (LOS), and level of independence (Functional Ambulation Classification, FAC). Results. Within 18 months, 179 participants were randomized. The groups were balanced for age, gender, time from onset of stroke to entry, initial velocity, and level of walking-related disability. The walking speed at discharge for DRS (0.91 m/s) was greater (P = .01) than that for NRS (0.72 m/s). No difference was found for LOS. LOS for both DRS and NRS was significantly shorter, however, for those who had mean walking speeds >0.4 m/s at entry. The DRS group did not have a higher proportion of FAC independent walkers (P = .1) and did not walk longer distances (P = .09). Conclusions. An Internet-based collaboration of 18 centers found that feedback about performance once a day produced gains in walking speed large enough to permit unlimited, slow community ambulation at discharge from inpatient rehabilitation.