Specialized orthotic care to improve functioning in adults with neuromuscular disorders: results of an open-label blinded end-point randomized controlled trial.

IF 3.4 3区 医学 Q1 REHABILITATION
Elza VAN Duijnhoven, Fieke S Koopman, Jana Tuijtelaars, Viola Altmann, Johanna M VAN Dongen, Manon Janse, Frans Nollet, Merel-Anne Brehm
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引用次数: 0

Abstract

Background: People with neuromuscular disorders (NMD) are often provided with lower limb orthoses to improve walking. Guideline-based provision of lower limb orthoses in expert settings (i.e. specialized orthotic care) may improve treatment outcomes by better matching the orthotic properties to address walking problems in neuromuscular disorders (NMD).

Aim: We assessed the (cost)-effectiveness of specialized orthotic care compared to usual orthotic care in adults with NMD.

Design: Randomized controlled trial with an economic evaluation.

Setting: Outpatient rehabilitation settings.

Population: Adults with plantar flexor and/or quadriceps weakness due to NMD with an indication for a lower limb orthosis.

Methods: Participants were randomly assigned to specialized orthotic care (N.=31), or usual orthotic care (N.=30). Primary endpoints were personal goal attainment (at 24 weeks follow-up), and walking energy cost at comfortable speed (change from baseline to 24 weeks follow-up). Secondary endpoints included comfortable walking speed, spatiotemporal gait parameters, gait biomechanics, stability, physical functioning, (fear of) falling, fatigue and satisfaction.

Results: Personal goal attainment was significantly higher for specialized orthotic care (P=0.011). Walking energy cost did not differ between groups (P=0.140) but decreased significantly with -11.8% (-0.55 J/kg/m; 95% CI: -0.99 to -0.11) following specialized, but not following usual orthotic care (-0.08 J/kg/m; 95% CI: -0.32 to 0.26). Secondarily, changes in step length, walking speed, physical functioning, and satisfaction were in favor of specialized orthotic care (P≤0.042). Specialized orthotic care was likely cost-effective from a societal and healthcare perspective.

Conclusions: Specialized orthotic care was beneficial in attaining personal goals, and likely cost-effective compared to usual orthotic care.

Clinical rehabilitation impact: Guideline-based provision of lower limb orthoses in expert settings could enhance functioning of adults with NMD and generate societal cost savings.

Abstract Image

Abstract Image

专门的矫形护理改善成人神经肌肉疾病的功能:一项开放标签盲法终点随机对照试验的结果。
背景:神经肌肉疾病(NMD)患者经常使用下肢矫形器来改善行走。在专家环境中提供基于指南的下肢矫形器(即专门的矫形护理)可以通过更好地匹配矫形器特性来解决神经肌肉疾病(NMD)的行走问题,从而改善治疗结果。目的:我们对成人NMD患者进行专业矫形治疗与常规矫形治疗的(成本)-效果评估。设计:随机对照试验,进行经济评价。设置:门诊康复设置。人群:由于NMD导致的足底屈肌和/或股四头肌无力的成年人,并有下肢矫形术的适应症。方法:参与者被随机分配到专门的矫形护理组(n =31)或普通的矫形护理组(n =30)。主要终点是个人目标实现(24周随访)和舒适速度下的步行能量消耗(从基线到24周随访的变化)。次要终点包括舒适步行速度、时空步态参数、步态生物力学、稳定性、身体功能、(对)跌倒的恐惧、疲劳和满意度。结果:专科矫形护理的个人目标达成率显著高于专科矫形护理(P=0.011)。行走能量成本在两组之间没有差异(P=0.140),但在专业矫形护理后显著下降了11.8% (-0.55 J/kg/m; 95% CI: -0.99至-0.11),而在常规矫形护理后没有下降(-0.08 J/kg/m; 95% CI: -0.32至0.26)。其次,步长、步行速度、身体功能和满意度的变化有利于专科矫形护理(P≤0.042)。从社会和医疗保健的角度来看,专业矫形护理可能具有成本效益。结论:与常规矫形护理相比,专业矫形护理有助于实现个人目标,并且可能具有成本效益。临床康复影响:在专家环境中提供基于指南的下肢矫形器可以增强NMD成人的功能,并产生社会成本节约。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
8.50
自引率
4.40%
发文量
162
审稿时长
6-12 weeks
期刊介绍: The European Journal of Physical and Rehabilitation Medicine publishes papers of clinical interest in physical and rehabilitation medicine.
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