The efficacy of gait rehabilitations for the treatment of incomplete spinal cord injury: a systematic review and network meta-analysis

Journal of Orthopaedic Surgery and Research

Systematic Review

Ammarin Thakkinstian¹  Sasivimol Rattanasiri¹  Thunyarat Anothaisintawee²  Patarawan Woratanarat³  Krongkaew Klaewkasikum³  Tanyaporn Patathong³  Thira Woratanarat⁴ 

[1] Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 10400, Bangkok, Thailand;Department of Family Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 10400, Bangkok, Thailand;Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Payathai, Ratchathewi, 10400, Bangkok, Thailand;Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, 10330, Bangkok, Thailand;

关键词: Functional electrical stimulation;    Physical therapy;    Robotic-assisted gait training;    Treadmill;    Walking;   

DOI  :  10.1186/s13018-022-03459-w

 received in 2022-04-06, accepted in 2022-12-16,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundRecent pieces of evidence about the efficacy of gait rehabilitation for incomplete spinal cord injury remain unclear. We aimed to estimate the treatment effect and find the best gait rehabilitation to regain velocity, distance, and Walking Index Spinal Cord Injury (WISCI) among incomplete spinal cord injury patients.MethodPubMed and Scopus databases were searched from inception to October 2022. Randomized controlled trials (RCTs) were included in comparison with any of the following: conventional physical therapy, treadmill, functional electrical stimulation and robotic-assisted gait training, and reported at least one outcome. Two reviewers independently selected the studies and extracted the data. Meta-analysis was performed using random-effects or fixed-effect model according to the heterogeneity. Network meta-analysis (NMA) was indirectly compared with all interventions and reported as pooled unstandardized mean difference (USMD) and 95% confidence interval (CI). Surface under the cumulative ranking curve (SUCRA) was calculated to identify the best intervention.ResultsWe included 17 RCTs (709 participants) with the mean age of 43.9 years. Acute-phase robotic-assisted gait training significantly improved the velocity (USMD 0.1 m/s, 95% CI 0.05, 0.14), distance (USMD 64.75 m, 95% CI 27.24, 102.27), and WISCI (USMD 3.28, 95% CI 0.12, 6.45) compared to conventional physical therapy. In NMA, functional electrical stimulation had the highest probability of being the best intervention for velocity (66.6%, SUCRA 82.1) and distance (39.7%, SUCRA 67.4), followed by treadmill, functional electrical stimulation plus treadmill, robotic-assisted gait training, and conventional physical therapy, respectively.ConclusionFunctional electrical stimulation seems to be the best treatment to improve walking velocity and distance for incomplete spinal cord injury patients. However, a large-scale RCT is required to study the adverse events of these interventions.Trial registration: PROSPERO number CRD42019145797.

【 授权许可】

CC BY   
© The Author(s) 2023

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