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Effectiveness of the Mobility Rehab System for Mobility Training in Older Adults: A Pragmatic Clinical Trial

Introduction: Mobility impairments are among the main causes of falls in older adults and patients with neurological diseases, leading to functional dependence and substantial health care costs. Feedback-based interventions applied in controlled, laboratory environments have shown promising results...

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Autores principales: Vitório, Rodrigo, El-Gohary, Mahmoud, Pearson, Sean, Carlson-Kuhta, Patricia, Harker, Graham, Horak, Fay B., Lapidus, Jodi, Studer, Mike, Mancini, Martina
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8451718/
https://www.ncbi.nlm.nih.gov/pubmed/34552549
http://dx.doi.org/10.3389/fneur.2021.680637
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author Vitório, Rodrigo
El-Gohary, Mahmoud
Pearson, Sean
Carlson-Kuhta, Patricia
Harker, Graham
Horak, Fay B.
Lapidus, Jodi
Studer, Mike
Mancini, Martina
author_facet Vitório, Rodrigo
El-Gohary, Mahmoud
Pearson, Sean
Carlson-Kuhta, Patricia
Harker, Graham
Horak, Fay B.
Lapidus, Jodi
Studer, Mike
Mancini, Martina
author_sort Vitório, Rodrigo
collection PubMed
description Introduction: Mobility impairments are among the main causes of falls in older adults and patients with neurological diseases, leading to functional dependence and substantial health care costs. Feedback-based interventions applied in controlled, laboratory environments have shown promising results for mobility rehabilitation, enhancing the benefits of standard therapy. However, the effectiveness of sensor-based feedback to improve gait in actual outpatient physical therapy settings is unknown. The proposed trial examines the effectiveness of a physical therapist-assisted, visual feedback system using wearable inertial sensors, Mobility Rehab, for mobility training in older adults with gait disturbances in an outpatient clinic. Methods: The study is a single site, pragmatic clinical trial in older adults with gait disturbances. Two hundred patients undergoing their outpatient rehabilitation program are assigned, by an independent assistant, for screening by one of four therapists, and assigned to either a standard physical therapy or therapist-assisted feedback therapy. Both groups train twice a week for 6 weeks. Four physical therapists were randomized and stratified by years of experience to deliver standard therapy or therapist-assisted feedback rehabilitation. Each session is 45 min long. Gait is trained for 30 min. The additional 15 min include exercises for endurance, strength, and static and dynamic balance in functional tasks. Mobility Rehab uses unobtrusive, inertial sensors on the feet and belt with real-time algorithms to provide real-time feedback on gait metrics (i.e., gait speed, double support time, foot clearance, angle at foot strike, and arm swing), which are displayed on a hand-held monitor. Blinded assessments are carried out before and after the intervention. The primary outcome measure is subjects' perception of balance as measured by the Activities-specific Balance Confidence scale. Gait speed, as measured with wearable inertial sensors during walking, is the secondary outcome measure. Discussion: We hypothesize that therapist-assisted feedback rehabilitation will be more effective than standard rehabilitation for gait. Feedback of motor performance plays a crucial role in rehabilitation and objective characterization of gait impairments by Mobility Rehab has the potential to improve the accuracy of patient-specific gait feedback. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03869879.
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spelling pubmed-84517182021-09-21 Effectiveness of the Mobility Rehab System for Mobility Training in Older Adults: A Pragmatic Clinical Trial Vitório, Rodrigo El-Gohary, Mahmoud Pearson, Sean Carlson-Kuhta, Patricia Harker, Graham Horak, Fay B. Lapidus, Jodi Studer, Mike Mancini, Martina Front Neurol Neurology Introduction: Mobility impairments are among the main causes of falls in older adults and patients with neurological diseases, leading to functional dependence and substantial health care costs. Feedback-based interventions applied in controlled, laboratory environments have shown promising results for mobility rehabilitation, enhancing the benefits of standard therapy. However, the effectiveness of sensor-based feedback to improve gait in actual outpatient physical therapy settings is unknown. The proposed trial examines the effectiveness of a physical therapist-assisted, visual feedback system using wearable inertial sensors, Mobility Rehab, for mobility training in older adults with gait disturbances in an outpatient clinic. Methods: The study is a single site, pragmatic clinical trial in older adults with gait disturbances. Two hundred patients undergoing their outpatient rehabilitation program are assigned, by an independent assistant, for screening by one of four therapists, and assigned to either a standard physical therapy or therapist-assisted feedback therapy. Both groups train twice a week for 6 weeks. Four physical therapists were randomized and stratified by years of experience to deliver standard therapy or therapist-assisted feedback rehabilitation. Each session is 45 min long. Gait is trained for 30 min. The additional 15 min include exercises for endurance, strength, and static and dynamic balance in functional tasks. Mobility Rehab uses unobtrusive, inertial sensors on the feet and belt with real-time algorithms to provide real-time feedback on gait metrics (i.e., gait speed, double support time, foot clearance, angle at foot strike, and arm swing), which are displayed on a hand-held monitor. Blinded assessments are carried out before and after the intervention. The primary outcome measure is subjects' perception of balance as measured by the Activities-specific Balance Confidence scale. Gait speed, as measured with wearable inertial sensors during walking, is the secondary outcome measure. Discussion: We hypothesize that therapist-assisted feedback rehabilitation will be more effective than standard rehabilitation for gait. Feedback of motor performance plays a crucial role in rehabilitation and objective characterization of gait impairments by Mobility Rehab has the potential to improve the accuracy of patient-specific gait feedback. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03869879. Frontiers Media S.A. 2021-09-06 /pmc/articles/PMC8451718/ /pubmed/34552549 http://dx.doi.org/10.3389/fneur.2021.680637 Text en Copyright © 2021 Vitório, El-Gohary, Pearson, Carlson-Kuhta, Harker, Horak, Lapidus, Studer and Mancini. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Vitório, Rodrigo
El-Gohary, Mahmoud
Pearson, Sean
Carlson-Kuhta, Patricia
Harker, Graham
Horak, Fay B.
Lapidus, Jodi
Studer, Mike
Mancini, Martina
Effectiveness of the Mobility Rehab System for Mobility Training in Older Adults: A Pragmatic Clinical Trial
title Effectiveness of the Mobility Rehab System for Mobility Training in Older Adults: A Pragmatic Clinical Trial
title_full Effectiveness of the Mobility Rehab System for Mobility Training in Older Adults: A Pragmatic Clinical Trial
title_fullStr Effectiveness of the Mobility Rehab System for Mobility Training in Older Adults: A Pragmatic Clinical Trial
title_full_unstemmed Effectiveness of the Mobility Rehab System for Mobility Training in Older Adults: A Pragmatic Clinical Trial
title_short Effectiveness of the Mobility Rehab System for Mobility Training in Older Adults: A Pragmatic Clinical Trial
title_sort effectiveness of the mobility rehab system for mobility training in older adults: a pragmatic clinical trial
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8451718/
https://www.ncbi.nlm.nih.gov/pubmed/34552549
http://dx.doi.org/10.3389/fneur.2021.680637
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