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Activity-based therapy for recovery of walking in individuals with chronic spinal cord injury: results from a randomized clinical trial [with consumer summary]
Jones ML, Evans N, Tefertiller C, Backus D, Sweatman M, Tansey K, Morrison S
Archives of Physical Medicine and Rehabilitation 2014 Dec;95(12):2239-2246
clinical trial
5/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: No; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To examine the effects of activity-based therapy (ABT) on neurologic function, walking ability, functional independence, metabolic health, and community participation. DESIGN: Randomized controlled trial (RCT) with delayed treatment design. SETTING: Outpatient program in a private, non-profit rehabilitation hospital. PARTICIPANTS: Volunteer sample of adults (n = 48; 37 male; 11 female, 18 to 66 years) with chronic (>= 12 months post-injury), motor-incomplete (AIS C or D) SCI. INTERVENTIONS: 9 hours/week of ABT for 24 weeks including developmental sequencing; resistance training; repetitive, patterned motor activity; and task-specific locomotor training. Algorithms were used to guide group allocation, FES utilization, and locomotor training progression. MAIN OUTCOME MEASURES: Neurologic function (International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI)); walking speed and endurance (10-meter walk test (10MWT), 6-minute walk test (6MWT), Timed Up and Go (TUG)) community participation (Spinal Cord Independence Measure, version III (SCIM-III), Reintegration to Normal Living Index (RNL)); metabolic function (weight, body mass index, Quantitative Insulin Sensitivity Check (QUICKI)). RESULTS: Significant improvements in neurologic function were noted for experimental versus control groups (ISNCSCI Total Motor Score (5.1 +/- 6.3 versus 0.9 +/- 5.0; p = 0.024) and LEMS (4.2 +/- 5.2 versus -0.6 +/- 4.2; p = 0.004)). Significant differences between experimental and control groups were observed for 10MWT speed (0.096 +/- 0.14 m/sec versus 0.027 +/- 0.10 m/sec; p = 0.036) and 6MWT total distance (35.97 +/- 48.2 m versus 3.0 +/- 25.5 m; p = 0.002). CONCLUSIONS: ABT has the potential to promote neurologic recovery and enhance walking ability in individuals with chronic, motor incomplete SCI. However, further analysis is needed to determine for whom ABT is going to lead to meaningful clinical benefits.

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