Body-weight-supported treadmill rehabilitation after stroke.
Body-weight-supported treadmill rehabilitation after stroke.
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DOI：
10.1056/nejmoa1010790
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发表时间：
2011-05-26
期刊：
影响因子：
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通讯作者：
LEAPS Investigative Team
中科院分区：
文献类型：
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作者：
Duncan PW;Sullivan KJ;Behrman AL;Azen SP;Wu SS;Nadeau SE;Dobkin BH;Rose DK;Tilson JK;Cen S;Hayden SK;LEAPS Investigative Team
运动训练，包括在跑步机上使用体重支持，是一种物理治疗干预，用于改善中风后行走能力的恢复。这种干预的有效性和适当时机尚未确定。我们根据行走障碍的程度对408名2个月前中风的参与者进行了分层——中度（能够行走0.4至<0.8米/秒）或重度（能够行走<0.4米/秒）——并将他们随机分配到三个训练组中的一个。第一组在中风发生2个月后在跑步机上使用体重支持进行训练（早期运动训练），第二组在中风发生6个月后进行训练（晚期运动训练），第三组在中风发生2个月后参加由物理治疗师管理的家庭运动计划（家庭运动计划）。每次干预包括36次，每次90分钟，持续12至16周。主要结果是卒中后1年，每组中功能性行走能力改善的参与者比例。1年后，52.0%的参与者的功能性行走能力有所提高。早期运动训练和家庭运动在改善方面无显著差异（主要结局的校正优势比为0.83；95%可信区间[CI]为0.50至1.39），晚期运动训练和家庭运动在改善方面无显著差异（校正优势比为1.19；95% CI为0.72至1.99）。所有组在步行速度、运动恢复、平衡、功能状态和生活质量方面都有类似的改善。延迟开始晚期运动训练和初始损伤的严重程度都不影响1年的结果。报告了10个相关的严重不良事件（2.2%的参与者进行早期运动训练，3.5%的参与者进行后期运动训练，1.6%的参与者进行家庭运动）。与家庭运动组相比，接受运动训练的各组在治疗期间出现头晕或昏厥的频率更高（P=0.008）。在严重行走障碍患者中，接受早期运动训练组的多次跌倒发生率高于其他两组（P = 0.02）。运动训练，包括在踏车上使用体重支持，并没有表现出优于在家由物理治疗师管理的渐进式运动。（由国家神经疾病和中风研究所和国家医学康复研究中心资助；LEAPS ClinicalTrials.gov号码，NCT00243919。）
Locomotor training, including the use of body-weight support in treadmill stepping, is a physical therapy intervention used to improve recovery of the ability to walk after stroke. The effectiveness and appropriate timing of this intervention have not been established. We stratified 408 participants who had had a stroke 2 months earlier according to the extent of walking impairment — moderate (able to walk 0.4 to <0.8 m per second) or severe (able to walk <0.4 m per second) — and randomly assigned them to one of three training groups. One group received training on a treadmill with the use of body-weight support 2 months after the stroke had occurred (early locomotor training), the second group received this training 6 months after the stroke had occurred (late locomotor training), and the third group participated in an exercise program at home managed by a physical therapist 2 months after the stroke (home-exercise program). Each intervention included 36 sessions of 90 minutes each for 12 to 16 weeks. The primary outcome was the proportion of participants in each group who had an improvement in functional walking ability 1 year after the stroke. At 1 year, 52.0% of all participants had increased functional walking ability. No significant differences in improvement were found between early locomotor training and home exercise (adjusted odds ratio for the primary outcome, 0.83; 95% confidence interval [CI], 0.50 to 1.39) or between late locomotor training and home exercise (adjusted odds ratio, 1.19; 95% CI, 0.72 to 1.99). All groups had similar improvements in walking speed, motor recovery, balance, functional status, and quality of life. Neither the delay in initiating the late locomotor training nor the severity of the initial impairment affected the outcome at 1 year. Ten related serious adverse events were reported (occurring in 2.2% of participants undergoing early locomotor training, 3.5% of those undergoing late locomotor training, and 1.6% of those engaging in home exercise). As compared with the home-exercise group, each of the groups receiving locomotor training had a higher frequency of dizziness or faintness during treatment (P=0.008). Among patients with severe walking impairment, multiple falls were more common in the group receiving early locomotor training than in the other two groups (P = 0.02). Locomotor training, including the use of body-weight support in stepping on a treadmill, was not shown to be superior to progressive exercise at home managed by a physical therapist. (Funded by the National Institute of Neurological Disorders and Stroke and the National Center for Medical Rehabilitation Research; LEAPS ClinicalTrials.gov number, NCT00243919.)