DOI QR코드

DOI QR Code

Effect of Rehabilitation Intervention for Lifestyle Improvement of Spinal Cord Injury: Systematic Review of Randomized Controlled Trials and Meta-Analysis

척수 손상 환자의 라이프 스타일 개선을 위한 재활 중재 효과: 무작위 대조군 연구의 체계적 고찰 및 메타분석

  • Ha, Sung Kyu (Dept. of Occupational Therapy, Graduate School, Yonsei University) ;
  • Park, Hae Yean (Dept. of Occupational Therapy, College of Health Science, Yonsei University)
  • 하성규 (연세대학교 일반대학원 작업치료학과) ;
  • 박혜연 (연세대학교 보건과학대학 작업치료학과)
  • Received : 2020.01.28
  • Accepted : 2020.02.25
  • Published : 2020.11.30

Abstract

Objective : The purpose of this study was to investigate the effectiveness and basis of rehabilitation intervention in patients with spinal cord injury by systematic review and meta-analysis of randomized controlled studies. Methods : Two researchers independently searched and selected a study published in an academic journal using a search term in an international thesis database. A total of 21 studies met the selection criteria, and qualitative evaluation of the study was conducted using the PEDro Scale. Meta-analysis was performed using Comprehensive Meta-Analysis 3.0 program. Results : A total of 713 subjects were included. The results of the meta-analysis showed a score of 0.406 (95.0% confidence interval: 0.221 ~ 0.591) for intervention using physical activity and 0.505 (95.0% confidence interval: 0.449 ~ 1.528) for electronic stimulation therapy, which showed medium effect; educational intervention had a 0.248 (95.0% confidence interval: 0.033 ~ 0.464), and mixed intervention 0.280 (95.0% confidence interval: 0.122 ~ 0.438). It was shown that the effect of small (small). There was a significant heterogeneity in the statistical heterogeneity test, and thus the random effects model was selected and analyzed. Conclusion : The results showed that rehabilitation interventions were effective for patients with spinal cord injury. During the rehabilitation of spinal cord injury patients, clinicians are expected to contribute to the development of programs to improve their lifestyles.

목적 : 척수손상환자를 대상으로 한 무작위 대조군 연구의 체계적 고찰과 메타분석을 통해 척수손상환자의 재활 중재의 효과성과 근거를 알아보고자 한다. 연구방법 : 국외 논문데이터베이스에서 검색어를 사용하여 학술지에 게재된 연구를 2명의 연구자가 독립적으로 검색하여 선정하였다. 선정기준에 부합한 연구는 총 21편이었고, PEDro Scale을 사용하여 연구의 질적 평가를 실시하였다. 메타분석은 Comprehensive Meta-Analysis 3.0 프로그램을 사용하였다. 결과 : 분석된 연구에 참여한 연구대상자는 총 713명이었고, 메타분석을 실시한 결과 신체활동을 이용한 중재는 0.406(95.0% 신뢰구간: 0.221~0.591), 전기 자극 치료중재는 0.505(95.0% 신뢰구간: 0.449~1.528)로 중간크기(Medium)의 효과를 보이는 것으로 나타났고 교육적 방법 중재는 0.248(95.0% 신뢰구간: 0.033~0.464), 복합 중재는 0.280(95.0% 신뢰구간: 0.122~0.438)로 작은 크기(Small)의 효과를 보이는 것으로 나타났다. 통계적 이질성 검정에서 유의미한 이질성이 있어 연구결과 통합 시 랜덤효과 모형을 선택하여 분석하였고, 출판편견은 유의미하지 않아 신뢰할만한 연구결과였다. 결론 : 분석된 결과 척수손상환자를 대상으로한 재활 중재는 효과적임을 알 수 있었다. 척수손상환자를 대상으로한 재활분야에서 임상가들이 대상자의 라이프 스타일을 개선하기 위한 프로그램을 구성할 때 기여할 것으로 사료된다.

Keywords

References

  1. Arbour-Nicitopoulos, K. P., Ginis, K. A. M., & Latimer, A. (2009). Planning, leisure-time physical activity, and coping self-efficacy in persons with spinal cord injury: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 90(12), 2003-2011. doi:10.1016/j.apmr.2009.06.019
  2. Arbour-Nicitopoulos, K. P., Sweet, S. N., Lamontagne, M.-E., Ginis, K. A. M., Jeske, S., Routhier, F., & Latimer-Cheung, A. E. (2017). A randomized controlled trial to test the efficacy of the SCI Get Fit Toolkit on leisure-time physical activity behaviour and social-cognitive processes in adults with spinal cord injury. Spinal Cord Series and Cases, 3, 1-8. doi:10.1038/scsandc.2017.44
  3. Borenstein, M., Hedges, L. V., Higgins, J. P., & Rothstein, H. R. (2011). Power analysis for meta-analysis. In M. Borenstein, L. V. Hedges, J. P. Higgins, & H. R. Rothstein (Eds.), Introduction to meta-analysis(1st ed., pp. 257-276). Hobeken, NJ: John Wiley & Sons Inc. doi:10.1002/9780470743386.ch29
  4. Chang, S. H., Afzal, T., Berliner, J., & Francisco, G. E. (2018). Exoskeleton-assisted gait training to improve gait in individuals with spinal cord injury: A pilot randomized study. Pilot and Feasibility Studies, 4(1), 1-10. doi:10.1186/s40814-018-0247-y
  5. Chase, T., Jha, A., Brooks, C., & Allshouse, A. (2013). A pilot feasibility study of massage to reduce pain in people with spinal cord injury during acute rehabilitation. Spinal Cord, 51(11), 847-851. doi:10.1038/sc.2013.104
  6. Cheung, E. Y. Y., Yu, K. K. K., Kwan, R. L. C., Ng, C. K. M., Chau, R. M. W., & Cheing, G. L. Y. (2019). Effect of EMG-biofeedback robotic-assisted body weight supported treadmill training on walking ability and cardiopulmonary function on people with subacute spinal cord injuries - A randomized controlled trial. BMC Neurology, 19(1), 1-9. doi:10.1186/s12883-019-1361-z
  7. Christiansen, C., & Baum, C. (1997). Occupational therapy: Enabling function and well-being. British Journal of Occupational Therapy, 61(8), 383. doi:10.1177/030802269806100812
  8. Cohen, M. A. (1988). Some new evidence on the seriousness of crime. Criminology, 26(2), 343-353. doi:10.1111/j.1745-9125.1988.tb00845.x
  9. Cramp, F., Berry, J., Gardiner, M., Smith, F., & Stephens, D. (2013). Health behaviour change interventions for the promotion of physical activity in rheumatoid arthritis: A systematic review. Musculoskeletal Care, 11(4), 238-247. doi:10.1002/msc.1049
  10. Dorstyn, D., Mathias, J., Denson, L., & Robertson, M. (2012). Effectiveness of telephone counseling in managing psychological outcomes after spinal cord injury: A preliminary study. Archives of Physical Medicine and Rehabilitation, 93(11), 2100-2108. doi:10.3410/f.718172940.793488135
  11. Fernhall, B., Heffernan, K., Jae, S. Y., & Hedrick, B. (2008). Health implications of physical activity in individuals with spinal cord injury: A literature review. Journal of Health and Human Services Administration, 30(4), 468-502. doi:10.1123/jpah.2018-0034
  12. Ferrier, S., Blanchard, C. M., Vallis, M., & Giacomantonio, N. (2011). Behavioural interventions to increase the physical activity of cardiac patients: A review. European Journal of Cardiovascular Prevention & Rehabilitation, 18(1), 15-32. doi:10.1097/01.hcr.0000361198.10773.01
  13. Field-Fote, E. C., & Roach, K. E. (2011). Influence of a locomotor training approach on walking speed and distance in people with chronic spinal cord injury: A randomized clinical trial. Physical Therapy, 91(1), 48-60. doi:10.2522/ptj.20090359
  14. Giangregorio, L., Catharine, C., Richards, K., Kapadia, N., Hitzig, S. L., Masani, K., & Popovic, M. R. (2012). A randomized trial of functional electrical stimulation for walking in incomplete spinal cord injury: Effects on body composition. The Journal of Spinal Cord Medicine, 35(5), 351-360. doi:10.1179/2045772312y.0000000041
  15. Hitzig, S., Craven, B., Panjwani, A., Kapadia, N., Giangregorio, L., Richards, K., ... Popovic, M. (2013). Randomized trial of functional electrical stimulation therapy for walking in incomplete spinal cord injury: Effects on quality of life and community participation. Topics in Spinal Cord Injury Rehabilitation, 19(4), 245-258. doi:10.1310/sci1904-245
  16. Hoffman, L., & Field-Fote, E. (2013). Effects of practice combined with somatosensory or motor stimulation on hand function in persons with spinal cord injury. Topics in Spinal Cord Injury Rehabilitation, 19(4), 288-299. doi:10.1310/sci1904-288
  17. Huedo-Medina, T. B., Sanchez-Meca, J., Marin-Martinez, F., & Botella, J. (2006). Assessing heterogeneity in meta-analysis: Q statistic or I2index? Psychological Methods, 11(2), 193-206. doi:10.1037/1082-989x.11.2.193
  18. Johnston, T. E., Modlesky, C. M., Betz, R. R., & Lauer, R. T. (2011). Muscle changes following cycling and/or electrical stimulation in pediatric spinal cord injury. Archives of Physical Medicine and Rehabilitation, 92(12), 1937-1943. doi:10.1038/sj.sc.3100792
  19. Jones, M. L., Evans, N., Tefertiller, C., Backus, D., Sweatman, M., Tansey, K., & Morrison, S. (2014). Activity-based therapy for recovery of walking in individuals with chronic spinal cord injury: Results from a randomized clinical trial. Archives of Physical Medicine and Rehabilitation, 95(12), 2239-2246. doi:10.1016/j.rehab.2014.03.843
  20. Kapadia, N., Masani, K., Craven, B. C., Giangregorio, L. M., Hitzig, S. L., Richards, K., & Popovic, M. R. (2014). A randomized trial of functional electrical stimulation for walking in incomplete spinal cord injury: Effects on walking competency. The Journal of Spinal Cord Medicine, 37(5), 511-524. doi:10.1179/2045772314y.0000000263
  21. Kim, D. I., Lee, H., Lee, B. S., Kim, J., & Jeon, J. Y. (2015). Effects of a 6-week indoor hand-bike exercise program on health and fitness levels in people with spinal cord injury: A randomized controlled trial study. Archives of Physical Medicine and Rehabilitation, 96(11), 2033-2040. doi:10.1016/j.apmr.2015.07.010
  22. Kim, S. M. (2016). Lifestyle and retirement preparation for a single household (Doctoral dissertation). Chonnam National University, Gwangju.
  23. Kirby, R. L., Mitchell, D., Sabharwal, S., McCranie, M., & Nelson, A. L. (2016). Manual wheelchair skills training for community-dwelling veterans with spinal cord injury: A randomized controlled trial. Plos One, 11(12), e0168330. doi:10.1371/journal.pone.0168330
  24. Kooijmans, H., Post, M. W., Stam, H. J., Van der Woude, L. H., Spijkerman, D. C., Snoek, G. J., ... Group, A. (2017). Effectiveness of a self-management intervention to promote an active lifestyle in persons with long-term spinal cord injury: The HABITS randomized clinical trial. Neurorehabilitation and Neural Repair, 31(12), 991-1004. doi:10.1186/isrctn11233847
  25. Kressler, J., Nash, M. S., Burns, P. A., & Field-Fote, E. C. (2013). Metabolic responses to 4 different body weight-supported locomotor training approaches in persons with incomplete spinal cord injury. Archives of Physical Medicine and Rehabilitation, 94(8), 1436-1442. doi:10.1016/j.apmr.2013.02.018
  26. Lannem, A. M., Sorensen, M., Froslie, K. F., & Hjeltnes, N. (2009). Incomplete spinal cord injury, exercise and life satisfaction. Spinal Cord, 47(4), 295-300. https://doi.org/10.1038/sc.2008.117
  27. Lauer, R., Smith, B., Mulcahey, M., Betz, R., & Johnston, T. (2011). Effects of cycling and/or electrical stimulation on bone mineral density in children with spinal cord injury. Spinal Cord, 49(8), 917-923. doi:10.1038/sc.2011.19
  28. Manns, P. J., & Chad, K. E. (1999). Determining the relation between quality of life, handicap, fitness, and physical activity for persons with spinal cord injury. Archives of Physical Medicine and Rehabilitation, 80(12), 1566-1571. doi:10.1016/S0003-9993(99)90331-3
  29. Manley, A. F. (1996). Physical activity and health: A report of the surgeon general. U. S. Department of Health and Human Services: Diane Publishing. doi:10.1037/e525162010-001
  30. Nooijen, C. F., de Groot, S., Postma, K., Bergen, M. P., Stam, H. J., Bussmann, J., & Van den Berg-Emons, R. (2012). A more active lifestyle in persons with a recent spinal cord injury benefits physical fitness and health. Spinal Cord, 50(4), 320-323. doi:10.1038/sc.2011.152
  31. Nooijen, C. F., Stam, H. J., Schoenmakers, I., Sluis, T., Post, M., Twisk, J., & Van Den Berg-Emons, R. J. (2016). Working mechanisms of a behavioural intervention promoting physical activity in persons with subacute spinal cord injury. Journal of Rehabilitation Medicine, 48(7), 583-588. doi:10.2340/16501977-2110
  32. Noreau, L., & Shephard, R. J. (1995). Spinal cord injury, exercise and quality of life. Sports Medicine, 20(4), 226-250. doi:10.1007/springerreference_73549
  33. Ordonez, F. J., Rosety, M. A., Camacho, A., Rosety, I., Diaz, A. J., Fornieles, G., ... Rosety-Rodriguez, M. (2013). Arm-cranking exercise reduced oxidative damage in adults with chronic spinal cord injury. Archives of Physical Medicine and Rehabilitation, 94(12), 2336-2341. doi:10.1016/j.apmr.2013.05.029
  34. Pelletier, C., De Zepetnek, J. T., MacDonald, M., & Hicks, A. (2015). A 16-week randomized controlled trial evaluating the physical activity guidelines for adults with spinal cord injury. Spinal Cord, 53(5), 363-367. doi:10.1038/sc.2014.167
  35. Rosenthal, R., & Rubin, D. B. (1982). Comparing effect sizes of independent studies. Psychological Bulletin, 92(2), 500-504. doi:10.1037/0033-2909.92.2.500
  36. Shin, Y. C. (2019). Effectiveness of occupation based lifestyle intervention program for health management of community dwelling elderly (Master's Thesis). Yonsei University, Seoul.
  37. Tasiemski, T., Kennedy, P., Gardner, B. P., & Taylor, N. (2005). The association of sports and physical recreation with life satisfaction in a community sample of people with spinal cord injuries. NeuroRehabilitation, 20(4), 253-265. doi:10.3233/nre-2005-20403
  38. Tawashy, A., Eng, J., Lin, K., Tang, P., & Hung, C. (2009). Physical activity is related to lower levels of pain, fatigue and depression in individuals with spinal-cord injury: A correlational study. Spinal Cord, 47(4), 301-306. doi:10.1038/sc.2008.120
  39. van den Berg-Emons, H., Bussmann, J., Sluis, T., van Bergen, M., Van der Woude, L., & Stam, H. (2004). Restoration of the level of everyday physical activity during spinal cord injury rehabilitation: Preliminary results. Journal of Rehabilitation Research and Development, 41, S22.
  40. Vissers, M., Van den Berg-Emons, R., Sluis, T., Bergen, M., Stam, H., & Bussmann, H. (2008). Barriers to and facilitators of everyday physical activity in persons with a spinal cord injury after discharge from the rehabilitation centre. Journal of Rehabilitation Medicine, 40(6), 461-467. doi:10.2340/16501977-0191
  41. Warburton, D. E., Nicol, C. W., & Bredin, S. S. (2006). Health benefits of physical activity: The evidence. Journal of Canadian Medical Association, 174(6), 801-809. doi:10.1503/cmaj.051351
  42. Yu, D. H., Lee, J. S., Kim, H. M., & Hong, D. K. (2012). Systematic review and meta-analysis on the mediating effects of FES in stroke patients. Korean Journal of Occupational Therapy, 20(1), 111-126.
  43. Zeilig, G., Weingarden, H., Zwecker, M., Dudkiewicz, I., Bloch, A., & Esquenazi, A. (2012). Safety and tolerance of the ReWalk exoskeleton suit for ambulation by people with complete spinal cord injury: A pilot study. The Journal of Spinal Cord Medicine, 35(2), 96-101. doi:10.1179/2045772312Y.0000000003