Critically appraised paper: Task-oriented gait training that focuses on the safe and correct use of a walking aid may reduce falls in people with multiple sclerosis [commentary]

摘要

Summary of: Martini DN, Zeeboer E, Hildebrand A, Fling BW, HugosCL, Cameron MH. ADSTEP: Preliminary investigation of a multicomponent walking aid program in people with multiple sclerosis. ArchPhys Med Rehabil. 2018;99:2050–2058.Question: Does the Assistive Device Selection, Training and EducationProgram (ADSTEP) reduce falls and improve physical activity and timedmobility tests in people with multiple sclerosis? Design: Randomisedcontrolled trial with concealed allocation and blinded outcome assessment. Setting: Outpatient multiple sclerosis clinic in the Veterans AffairsPortland Health Care System, United States of America. Participants:Adults with multiple sclerosis who were currently using a walking aid,had fallen at least once in the previous year, were relapse-free for 30days, and able to walk at least 25 feet. Individuals with previous walkingaid training, dementia, deafness or blindness were excluded. Randomisation of 40 participants allocated 20 to ADSTEP and 20 to the controlgroup. Interventions: ADSTEP involved six training sessions providedonce a week by a physiotherapist. Training involved an initial assessment of walking aid use, safety, acceptability, functionality, and devicemodification if necessary. Subsequent sessions comprised progressive,task-specific gait training over different surfaces, turning, negotiatingdoorways, narrow spaces, stairs, and outdoor terrains. Head turning anddual-tasking were added as participants progressed. Participants randomised to the control group received usual medical care. Outcomemeasures: Primary outcomes were the number of falls in the 3 months following the intervention, and the Timed Up and Go, Timed 25-footWalk, 2-minute walk test and Four Square Step Test assessed postintervention and at the 3-month follow-up. Secondary outcomes werethe International Physical Activity Questionnaire short form, andpatient-reported walking aid satisfaction, balance confidence, and disease impact on everyday life. Results: All participants completed thestudy. There were significantly fewer fallers in ADSTEP (10 of 20) thanthe control group (16 of 20; number needed to treat (95% CI) = 3.3 (1.7 to51.6)) but no between-group differences in number of recurrent fallersand average total number of falls. There was no intervention effect onany of the timed mobility tests or patient-reported outcomes, and littleeffect on physical activity, except for reduced sitting time postintervention and at 3 months. Conclusion: Task-oriented assistivedevice training for people with multiple sclerosis may reduce falls andtime spent sitting. A larger, fully powered clinical trial is required toconfirm these preliminary findings.[95% CI calculated by the CAP Editor.]Provenance: Invited. Not peer reviewed.