Intensive Gait Training for Older Adults with Symptomatic Knee Osteoarthritis.
Intensive Gait Training for Older Adults with Symptomatic Knee Osteoarthritis.
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DOI：
10.1097/phm.0000000000000264
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发表时间：
2015-10
影响因子：
3
通讯作者：
Yack HJ
中科院分区：
文献类型：
--
作者：
Segal NA;Glass NA;Teran-Yengle P;Singh B;Wallace RB;Yack HJ
确定个体化步态训练是否比常规护理更有效地减少症状性膝关节骨关节炎（OA）患者的活动障碍和疼痛。年龄≥60岁、有症状的膝关节OA和活动受限的成年人被随机分配至在仪器跑步机上进行物理治疗师指导的步态训练，生物反馈个性化以优化膝关节运动，每两周一次，持续3个月或常规护理（对照）。通过LLFDI基本下肢功能评分（主要）定义移动残疾;通过基线、3、6和12个月时的定时400米步行、椅子站立和爬楼梯测试定义限制;通过膝关节损伤/骨关节炎结局评分定义症状。分析采用纵向混合模型。基线时，35名步态训练参与者（74.3%女性;年龄69.7±8.2岁）和21名对照参与者（57.1%女性;年龄68.9±6.5岁）之间无显著组间差异。在3个月时，步态训练参与者在行动能力障碍（4.3±1.7; p=0.0162）和症状（8.6±4.1; p=0.0420）方面有更大的改善。然而，在3个月时的疼痛、400米步行、椅子站立或爬楼梯时间以及6个月或12个月时的任何结局均未检测到组间差异。与常规治疗相比，个体化步态训练可立即改善有症状膝关节OA成人的活动能力和膝关节症状，但这些效果并不持久。
To determine whether individualized gait training is more effective than usual care for reducing mobility disability and pain in individuals with symptomatic knee osteoarthritis (OA). Adults age ≥60 with symptomatic knee OA and mobility limitations were randomized to physical therapist-directed gait training on an instrumented treadmill, with biofeedback individualized to optimize knee movements, biweekly for 3 months or usual care (control). Mobility disability was defined by LLFDI Basic Lower Limb Function score (primary); limitations by timed 400m walk, chair-stand, and stair-climb tests at baseline, 3, 6 and 12 months; and symptoms by the Knee Injury/Osteoarthritis Outcome Score. Analyses used longitudinal mixed models. There were no significant inter-group differences between the 35 gait-training (74.3% women; age 69.7±8.2 years) and 21 control (57.1% women; age 68.9±6.5 years) participants at baseline. At 3 months, gait-training participants had greater improvement in mobility disability (4.3±1.7; p=0.0162) and symptoms (8.6±4.1; p=0.0420). However, there were neither intergroup differences detected for pain, 400m walk, chair-stand or stair-climb times at 3 months nor for any outcomes at 6 or 12 months. Compared with usual care, individualized gait-training resulted in immediate improvements in mobility disability and knee symptoms in adults with symptomatic knee OA, but these effects were not sustained.