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Robotic walking to mitigate bone mineral density decline and adverse body composition in individuals with incomplete spinal cord injury: a pilot randomized clinical trial [with consumer summary]
Shackleton C, Evans R, West S, Derman W, Albertus Y
American Journal of Physical Medicine & Rehabilitation 2021 Dec 3:Epub ahead of print
clinical trial
5/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; 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 determine whether 24 weeks of Robotic Locomotor Training (RLT) or Activity-based Training (ABT) was sufficient time to induce bone mineral density (BMD) and body composition changes in individuals with spinal cord injury (SCI). This study reports the secondary analysis of a randomised pilot trial. DESIGN: Participants with chronic motor incomplete tetraplegia (n = 16) were recruited. Interventions involved 60-minute sessions, 3x per week, over 24-weeks. RLT involved walking in the Ekso GT suit. ABT involved a combination of resistance, cardiovascular and weight-bearing exercise. RESULTS: Hip BMD was maintained during RLT; however, it was significantly reduced (p = 0.04; effect size (ES) = 0.86) during ABT by 0.03 (-0.29 to 0.23) g/cm2 post intervention. Both interventions improved arm fat-free soft tissue mass (FFSTM), but neither group experienced changes in leg FFSTM. The ABT group had a significant decrease in visceral adipose tissue (p = 0.04; ES = 0.72) and gynoid fat mass (FM) (p = 0.01; ES = 0.62). CONCLUSIONS: 24 weeks of RLT is possibly a sufficient duration to prevent the progressive decline of BMD usually occurring in this population. A longitudinal period of ABT serves as an effective rehabilitation strategy to reduce indices of FM in individuals with SCI.

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