PDF(Pubmed)
Abstract：
People fall more often when their gait stability is reduced. Gait stability can be directly manipulated by exerting forces or moments onto a person, ranging from simple walking sticks to complex wearable robotics. A systematic review of the literature was performed to determine: What is the level of evidence for different types of mechanical manipulations on improving gait stability? The study was registered at PROSPERO (CRD42020180631). Databases Embase, Medline All, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and Google Scholar were searched. The final search was conducted on the 1st of December, 2022. The included studies contained mechanical devices that influence gait stability for both impaired and non-impaired subjects. Studies performed with prosthetic devices, passive orthoses, and analysing post-training effects were excluded. An adapted NIH quality assessment tool was used to assess the study quality and risk of bias. Studies were grouped based on the type of device, point of application, and direction of forces and moments. For each device type, a best-evidence synthesis was performed to quantify the level of evidence based on the type of validity of the reported outcome measures and the study quality assessment score. Impaired and non-impaired study participants were considered separately. From a total of 4701 papers, 53 were included in our analysis. For impaired subjects, indicative evidence was found for medio-lateral pelvis stabilisation for improving gait stability, while limited evidence was found for hip joint assistance and canes. For non-impaired subjects, moderate evidence was found for medio-lateral pelvis stabilisation and limited evidence for body weight support. For all other device types, either indicative or insufficient evidence was found for improving gait stability. Our findings also highlight the lack of consensus on outcome measures amongst studies of devices focused on manipulating gait.
摘要：
当步态稳定性降低时，人们跌倒的频率更高。步态稳定性可以通过向人施加力或力矩来直接操纵，从简单的手杖到复杂的可穿戴机器人。对文献进行了系统综述，以确定：不同类型的机械操作改善步态稳定性的证据水平如何？该研究在PROSPERO（CRD42020180631）注册。数据库Embase,MedlineAll,WebofScience核心合集,Cochrane中央控制试验登记册,和谷歌学者被搜索。最后的搜索是在12月1日进行的，2022年。所包括的研究包含影响受损和未受损受试者的步态稳定性的机械装置。用假肢装置进行的研究，被动矫形器，并分析培训后的影响被排除在外。采用适应的NIH质量评估工具评估研究质量和偏倚风险。研究根据设备类型进行分组，点的应用，力和力矩的方向。对于每种设备类型，根据报告的结局指标的有效性类型和研究质量评估评分,我们进行了最佳证据综合,以量化证据水平.受损和未受损的研究参与者分别考虑。从总共4701篇论文中，53个被包括在我们的分析中。对于受损的受试者，发现了骨盆内侧外侧稳定改善步态稳定性的指示性证据，而髋关节辅助和手杖的证据有限。对于未受损的受试者，骨盆内侧外侧稳定的证据为中度,体重支持的证据有限.对于所有其他设备类型，发现改善步态稳定性的指示性证据或证据不足。我们的发现还强调了在专注于操纵步态的设备研究中对结果测量缺乏共识。
