Repetitive locomotor training and physiotherapy improve walking and basic activities of daily living after stroke:: a single-blind, randomized multicentre trial (DEutsche GAngtrainerStudie, DEGAS)
Repetitive locomotor training and physiotherapy improve walking and basic activities of daily living after stroke:: a single-blind, randomized multicentre trial (DEutsche GAngtrainerStudie, DEGAS)
复制标题
DOI：
10.1177/0269215506071281
复制
发表时间：
2007-01-01
影响因子：
3
通讯作者：
Hesse, S.
中科院分区：
文献类型：
--
作者：
Pohl, M.;Werner, C.;Hesse, S.
目的：评价机械式步态训练机配合物理治疗对亚急性脑卒中患者重复性运动训练的效果。设计：随机对照试验。环境：四个德国神经康复中心。研究对象：155例非门诊患者（首次卒中< 60天）。干预：A组运动训练20 min，物理治疗25 min；B组每周进行45分钟物理治疗，连续4周。主要结局指标：主要变量为步态能力（功能行走类别，0-5）和Barthel指数（0-100），在研究开始、结束和6个月后随访时进行盲法评估。对治疗有反应的患者必须能够行走（功能行走类别4或5）或达到Barthel指数>= 75。次要变量是步行速度、耐力、活动性和腿部力量。结果：意向治疗分析显示，A组能够独立行走的患者数量显著增加：治疗结束时，A组77例患者中有41例，B组78例患者中有17例（P < 0.0001）。此外，A组患者达到Barthel指数>= 75的患者明显更多：77人中有44人达到Barthel指数，78人中有21人达到Barthel指数（P < 0.0001）。在6个月的随访中，A组的步态能力继续保持优势（77人中54人对78人中28人，P < 0.0001），而Barthel指数反应率没有差异。对于所有次要变量，A组患者在治疗期间改善明显（P < 0.0001），但在随访期间无明显改善。结论：与单纯物理治疗相比，强化运动训练加物理治疗可显著改善亚急性脑卒中患者的步态能力和日常生活能力。
Objective: To evaluate the effect of repetitive locomotor training on an electromechanical gait trainer plus physiotherapy in subacute stroke patients.Design: Randomized controlled trial.Setting: Four German neurological rehabilitation centres.Subjects: One hundred and fifty-five non-ambulatory patients (first-time stroke < 60 days). Intervention: Group A received 20 min locomotor training and 25 min physiotherapy; group B had 45 min physiotherapy every week day for four weeks.Main outcome measures: Primary variables were gait ability (Functional Ambulation Category, 0-5) and the Barthel Index (0-100), blindly assessed at study onset, end, and six months later for follow-up. Responders to the therapy had to become ambulatory (Functional Ambulation Category 4 or 5) or reach a Barthel Index of >= 75. Secondary variables were walking velocity, endurance, mobility and leg power.Results: The intention-to-treat analysis revealed that significantly greater number of patients in group A could walk independently: 41 of 77 versus 17 of 78 in group B (P < 0.0001) at treatment end. Also, significantly more group A patients had reached a Barthel Index >= 75: 44 of 77 versus 21 of 78 (P < 0.0001). At six-month follow-up, the superior gait ability in group A persisted (54 of 77 versus 28 of 78, P < 0.0001), while the Barthel Index responder rate did not differ. For all secondary variables, group A patients had improved significantly more (P < 0.0001) during the treatment period, but not during follow-up.Conclusions: Intensive locomotor training plus physiotherapy resulted in a significantly better gait ability and daily living competence in subacute stroke patients compared with physiotherapy alone.