Article

OBJECTIVE: To describe changes in and predictors of comfortable gait speed (GS-C)
after using a foot-drop stimulator (FDS; Bioness L300; Bioness Inc, Valencia, CA)
for 42 weeks in persons who had sustained a stroke. DESIGN: Secondary analysis of
prospective assessments. SETTING: Multicenter clinical trial. PARTICIPANTS: A
total of 99 subjects who had sustained a stroke >/= 3 months earlier and who had
GS-C </= 0.8 m/s and drop foot with a mean age of 60.7 years and a poststroke
time of 4.8 years. METHODS: GS-C was assessed at baseline and at 30 weeks with
and without use of an FDS (therapeutic effect) and at 6, 12, 30, 36, and 42 weeks
with use of an FDS (total effect). After subjects participated in 8 physical
therapy sessions, an FDS was used for ambulation over the course of 42 weeks.
MAIN OUTCOME MEASUREMENTS: Changes in mean GS-C over time, FDS "responder" status
defined as either >/= 0.1 m/s gain in GS-C (the minimal clinically important
difference [MCID]) or advancing by one Perry Ambulation Category (PAC), and the
incidence and nature of adverse events (AEs). RESULTS: A total of 74 (75%) and 69
(70%) of 99 subjects completed assessments at 30 weeks and 42 weeks,
respectively. Baseline GS-C was 0.42 m/s without use of an FDS and 0.49 m/s with
use of an FDS. GS-C improved to 0.54 m/s at 30 weeks without use of an FDS
(effect size = 0.75) and 0.54, 0.55, 0.58, 0.60, and 0.61 m/s at 6, 12, 30, 36,
and 42 weeks with use of an FDS, respectively (effect size 0.84 at 42 weeks).
Half of the subjects achieved a maximum GS-C by 12 weeks. Approximately 18% were
PAC responders and 29% were MCID responders for 30-week therapeutic effect, and
55% were PAC responders and 67% were MCID responders for 42-week total effect.
After logistic regression, the following factors emerged as the strongest
predictors of FDS responders: younger age, faster baseline GS-C and Timed Up and
Go, and balance. At 42 weeks, 60% reported a device-related AE; 92% were mild and
96% were anticipated. CONCLUSIONS: When an FDS was used, GS-C improved
progressively over 42 weeks, with >/= 50% of patients achieving a clinically
meaningful 42-week total effect and 50% achieving a maximum GS-C by 12 weeks.
Younger patients with greater mobility levels may benefit most from use of an
FDS. AEs were frequent, mild, and reversible.
CI - Copyright (c) 2014 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS