Longitudinal Recovery and Reduced Costs After 120 Sessions of Locomotor Training for Motor Incomplete Spinal Cord Injury
Longitudinal Recovery and Reduced Costs After 120 Sessions of Locomotor Training for Motor Incomplete Spinal Cord Injury
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DOI：
10.1016/j.apmr.2017.10.003
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发表时间：
2018-03-01
影响因子：
4.3
通讯作者：
Basso, D. Michele
中科院分区：
文献类型：
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作者：
Morrison, Sarah A.;Lorenz, Douglas;Basso, D. Michele
目的：确定慢性不完全性脊髓损伤（SCI）后长期体重支持运动训练的影响，并估计由于保险公司规定的访问限制而可能发生的与丧失恢复潜力和可预防的继发并发症相关的医疗费用。设计：前瞻性观察队列，纵向随访。环境：参与克里斯托弗和达纳里夫基金会神经恢复网络（NRN）的八个门诊康复中心。参与者：运动不完全性慢性脊髓损伤患者（美国脊髓损伤协会损伤量表C或D； N=69；脊髓损伤后0.1-45年），完成至少120次NRN物理治疗。干预措施：在身体跑步机环境中手动辅助运动训练（LT），地上站立和行走活动，以及社区整合任务。主要观察指标：脊髓损伤运动和感觉评分国际神经学分类标准、直立性低血压、肠/膀胱/性功能、脊髓损伤功能行走量表（SCI-FAI）、Berg平衡量表、改良功能范围、10米步行试验和6分钟步行试验。每20次治疗和治疗出院后6至12个月随访收集纵向结果测量值。结果：上肢和下肢运动强度、功能活动、心理觉醒、排便感觉和SCI-FAI社区活动均有显著改善。延长的训练在60、80、100和120次训练中可以实现最小的可检测变化。在可检测到的变化发生后，持续120个疗程，并在治疗后持续6至12个月。结论：进行至少120次的LT治疗可以改善不完全性慢性脊髓损伤的恢复。因为步行减少了再住院，超过平均20期保险限制的LT可以减少再住院和长期健康成本。(C) 2018年美国康复医学大会
Objective: To determine the impact of long-term, body weight supported locomotor training after chronic, incomplete spinal cord injury (SCI), and to estimate the health care costs related to lost recovery potential and preventable secondary complications that may have occurred because of visit limits imposed by insurers.Design: Prospective observational cohort with longitudinal follow-up.Setting: Eight outpatient rehabilitation centers that participate in the Christopher & Dana Reeve Foundation NeuroRecovery Network (NRN).Participants: Individuals with motor incomplete chronic SCI (American Spinal Injury Association Impairment Scale C or D; N=69; 0.1-45y after SCI) who completed at least 120 NRN physical therapy sessions.Interventions: Manually assisted locomotor training (LT) in a body treadmill environment, overground standing and stepping activities, and community integration tasks.Main Outcome Measures: International Standards for Neurological Classification of Spinal Cord Injury motor and sensory scores, orthostatic hypotension, bowel/bladder/sexual function, Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI), Berg Balance Scale, Modified Functional Reach, 10-m walk test, and 6-minute walk test. Longitudinal outcome measure collection occurred every 20 treatments and at 6- to 12-month follow-up after discharge from therapy.Results: Significant improvement occurred for upper and lower motor strength, functional activities, psychological arousal, sensation of bowel movement, and SCI-FAI community ambulation. Extended training enabled minimal detectable changes at 60, 80, 100, and 120 sessions. After detectable change occurred, it was sustained through 120 sessions and continued 6 to 12 months after treatment.Conclusions: Delivering at least 120 sessions of LT improves recovery from incomplete chronic SCI. Because walking reduces rehospitalization, LT delivered beyond the average 20-session insurance limit can reduce rehospitalizations and long-term health costs. (C) 2018 by the American Congress of Rehabilitation Medicine