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Pinto D, Heinemann AW, Chang SH, Charlifue S, Field-Fote EC, Furbish CL, Jayaraman A, Tefertiller C, Taylor HB, French DD. Cost-effectiveness analysis of overground robotic training versus conventional locomotor training in people with spinal cord injury. J Neuroeng Rehabil 2023; 20:10. [PMID: 36681852 PMCID: PMC9867867 DOI: 10.1186/s12984-023-01134-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/10/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Few, if any estimates of cost-effectiveness for locomotor training strategies following spinal cord injury (SCI) are available. The purpose of this study was to estimate the cost-effectiveness of locomotor training strategies following spinal cord injury (overground robotic locomotor training versus conventional locomotor training) by injury status (complete versus incomplete) using a practice-based cohort. METHODS A probabilistic cost-effectiveness analysis was conducted using a prospective, practice-based cohort from four participating Spinal Cord Injury Model System sites. Conventional locomotor training strategies (conventional training) were compared to overground robotic locomotor training (overground robotic training). Conventional locomotor training included treadmill-based training with body weight support, overground training, and stationary robotic systems. The outcome measures included the calculation of quality adjusted life years (QALYs) using the EQ-5D and therapy costs. We estimate cost-effectiveness using the incremental cost utility ratio and present results on the cost-effectiveness plane and on cost-effectiveness acceptability curves. RESULTS Participants in the prospective, practice-based cohort with complete EQ-5D data (n = 99) qualified for the analysis. Both conventional training and overground robotic training experienced an improvement in QALYs. Only people with incomplete SCI improved with conventional locomotor training, 0.045 (SD 0.28), and only people with complete SCI improved with overground robotic training, 0.097 (SD 0.20). Costs were lower for conventional training, $1758 (SD $1697) versus overground robotic training $3952 (SD $3989), and lower for those with incomplete versus complete injury. Conventional overground training was more effective and cost less than robotic therapy for people with incomplete SCI. Overground robotic training was more effective and cost more than conventional training for people with complete SCI. The incremental cost utility ratio for overground robotic training for people with complete spinal cord injury was $12,353/QALY. CONCLUSIONS The most cost-effective locomotor training strategy for people with SCI differed based on injury completeness. Conventional training was more cost-effective than overground robotic training for people with incomplete SCI. Overground robotic training was more cost-effective than conventional training for people with complete SCI. The effect estimates may be subject to limitations associated with small sample sizes and practice-based evidence methodology. These estimates provide a baseline for future research.
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Affiliation(s)
- Daniel Pinto
- Department of Physical Therapy, College of Health Sciences, Marquette University, Milwaukee, USA.
- World Health Organization Collaborating Center for the Epidemiology of Musculoskeletal Health and Aging, University of Liege, Liege, Belgium.
| | - Allen W Heinemann
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, USA
- Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Shuo-Hsiu Chang
- Neurorecovery Research Center, TIRR Memorial Hermann, Houston, USA
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, USA
| | | | - Edelle C Field-Fote
- Spinal Cord Injury, Shepherd Center, Atlanta, Georgia
- Division of Physical Therapy, Emory University, Atlanta, USA
| | | | - Arun Jayaraman
- Max Näder Center for Rehabilitation Technologies and Outcomes Research and Outcomes Research, Shirley Ryan AbilityLab, Chicago, USA
- Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | | | - Heather B Taylor
- Spinal Cord Injury and Disability Research, TIRR Memorial Hermann, Houston, USA
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, USA
| | - Dustin D French
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Center for Health Services and Outcomes Research, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Health Services Research and Development Service, US Department of Veterans Affairs, Chicago, USA
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Duddy D, Doherty R, Connolly J, Loughrey J, Condell J, Hassan D, Faulkner M. The Cardiorespiratory Demands of Treadmill Walking with and without the Use of Ekso GT™ within Able-Bodied Participants: A Feasibility Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6176. [PMID: 35627714 PMCID: PMC9141321 DOI: 10.3390/ijerph19106176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/04/2022] [Accepted: 05/14/2022] [Indexed: 12/07/2022]
Abstract
Individuals with neurological impairments tend to lead a predominantly sedentary lifestyle due to impaired gait function and mobility. This may be detrimental to health by negatively impacting cardiorespiratory fitness and muscular strength, and increasing the risk of developing secondary health problems. Powered exoskeletons are assistive devices that may aid neurologically impaired individuals in achieving the World Health Organisation's (WHO) physical activity (PA) guidelines for health. Increased PA should elicit a sufficient cardiorespiratory stimulus to provide health benefits to exoskeleton users. This study examined the cardiorespiratory demands of treadmill walking with and without the Ekso GT™ among able-bodied participants. The Ekso GT™ is a powered exoskeleton that enables individuals with neurological impairments to walk by supporting full body mass with motors attached at the hip and knee joints to generate steps. This feasibility study consisted of one group of healthy able-bodied individuals (n = 8). Participants completed two 12 min treadmill walking assessments, one with and one without the Ekso GT™ at the same fixed speed. Throughout each walking bout, various cardiorespiratory parameters, namely, volume of oxygen per kilogram (kg) of body mass (V˙O2·kg-1), volume of carbon dioxide per kg of body mass (V˙CO2·kg-1), respiratory exchange ratio (RER), ventilation (V˙E), heart rate (HR), and rate of perceived exertion (RPE), were recorded. Treadmill walking with Ekso GT™ elevated all recorded measurements to a significantly greater level (p ≤ 0.05) (except RER at 1 km·h-1; p = 0.230) than treadmill walking without the Ekso GT™ did at the same fixed speed. An increased cardiorespiratory response was recorded during treadmill walking with the exoskeleton. Exoskeleton walking may, therefore, be an effective method to increase PA levels and provide sufficient stimulus in accordance with the PA guidelines to promote cardiorespiratory fitness and subsequently enhance overall health.
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Affiliation(s)
- Damien Duddy
- Sports Lab North West, Atlantic Technological University Donegal, Letterkenny Campus, Port Road, F92 FC93 Letterkenny, Ireland; (R.D.); (M.F.)
| | - Rónán Doherty
- Sports Lab North West, Atlantic Technological University Donegal, Letterkenny Campus, Port Road, F92 FC93 Letterkenny, Ireland; (R.D.); (M.F.)
| | - James Connolly
- Department of Computing, Atlantic Technological University Donegal, Letterkenny Campus, Port Road, F92 FC93 Letterkenny, Ireland;
| | | | - Joan Condell
- School of Computing, Engineering and Intelligent Systems, Ulster University Magee, Londonderry BT48 7JL, UK;
| | - David Hassan
- Sport and Exercise Sciences Research Institute, Ulster University Jordanstown, Newtownabbey BT37 0QB, UK;
| | - Maria Faulkner
- Sports Lab North West, Atlantic Technological University Donegal, Letterkenny Campus, Port Road, F92 FC93 Letterkenny, Ireland; (R.D.); (M.F.)
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Laparidou D, Curtis F, Akanuwe J, Goher K, Niroshan Siriwardena A, Kucukyilmaz A. Patient, carer, and staff perceptions of robotics in motor rehabilitation: a systematic review and qualitative meta-synthesis. J Neuroeng Rehabil 2021; 18:181. [PMID: 34953497 PMCID: PMC8710022 DOI: 10.1186/s12984-021-00976-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/06/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In recent years, robotic rehabilitation devices have often been used for motor training. However, to date, no systematic reviews of qualitative studies exploring the end-user experiences of robotic devices in motor rehabilitation have been published. The aim of this study was to review end-users' (patients, carers and healthcare professionals) experiences with robotic devices in motor rehabilitation, by conducting a systematic review and thematic meta-synthesis of qualitative studies concerning the users' experiences with such robotic devices. METHODS Qualitative studies and mixed-methods studies with a qualitative element were eligible for inclusion. Nine electronic databases were searched from inception to August 2020, supplemented with internet searches and forward and backward citation tracking from the included studies and review articles. Data were synthesised thematically following the Thomas and Harden approach. The CASP Qualitative Checklist was used to assess the quality of the included studies of this review. RESULTS The search strategy identified a total of 13,556 citations and after removing duplicates and excluding citations based on title and abstract, and full text screening, 30 studies were included. All studies were considered of acceptable quality. We developed six analytical themes: logistic barriers; technological challenges; appeal and engagement; supportive interactions and relationships; benefits for physical, psychological, and social function(ing); and expanding and sustaining therapeutic options. CONCLUSIONS Despite experiencing technological and logistic challenges, participants found robotic devices acceptable, useful and beneficial (physically, psychologically, and socially), as well as fun and interesting. Having supportive relationships with significant others and positive therapeutic relationships with healthcare staff were considered the foundation for successful rehabilitation and recovery.
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Affiliation(s)
- Despina Laparidou
- grid.36511.300000 0004 0420 4262Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Brayford Pool, Lincolnshire, Lincoln, LN6 7TS UK
| | - Ffion Curtis
- grid.412934.90000 0004 0400 6629Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW UK
| | - Joseph Akanuwe
- grid.36511.300000 0004 0420 4262Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Brayford Pool, Lincolnshire, Lincoln, LN6 7TS UK
| | - Khaled Goher
- grid.36511.300000 0004 0420 4262School of Engineering, University of Lincoln, Brayford Pool, Lincolnshire, Lincoln, LN6 7DQ UK
| | - A. Niroshan Siriwardena
- grid.36511.300000 0004 0420 4262Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Brayford Pool, Lincolnshire, Lincoln, LN6 7TS UK
| | - Ayse Kucukyilmaz
- grid.4563.40000 0004 1936 8868School of Computer Science, University of Nottingham, Jubilee Campus, Wollaton Road, Nottingham, NG8 2DU UK
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Assessment Methods of Usability and Cognitive Workload of Rehabilitative Exoskeletons: A Systematic Review. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11157146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Robotic exoskeleton technologies are applied in the medical field to help patients with impaired mobility to recover their motor functions. Relevant literature shows that usability and cognitive workload may influence the patients’ likelihood to benefit from the use of rehabilitative exoskeletons. Following the PRISMA method, the present study aimed to systematically review the assessment methods of usability and cognitive workload in the use of exoskeletal devices for motor rehabilitation. The literature search was conducted in the Scopus and Web of Science bibliographical databases, using 16 keywords that were combined into one search query. A final sample of 23 articles was included in the review, from which 18 distinct assessment methods were identified. Of them, 15 aimed to assess usability, whereas 3 aimed to assess cognitive workload in the use of rehabilitative exoskeletons. Some of the identified methods (e.g., SUS, QUEST, SWAT, and NASA-TLX) showed good psychometric properties and were therefore proven to be appropriate to assess usability and cognitive workload while performing exoskeleton-based rehabilitation. The current study may contribute to the development of guidelines and analytical tools for exoskeletons’ usability and exoskeleton-related patients’ cognitive workload in the domain of medical rehabilitation.
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Duddy D, Doherty R, Connolly J, McNally S, Loughrey J, Faulkner M. The Effects of Powered Exoskeleton Gait Training on Cardiovascular Function and Gait Performance: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2021; 21:3207. [PMID: 34063123 PMCID: PMC8124924 DOI: 10.3390/s21093207] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/23/2021] [Accepted: 04/29/2021] [Indexed: 12/26/2022]
Abstract
Patients with neurological impairments often experience physical deconditioning, resulting in reduced fitness and health. Powered exoskeleton training may be a successful method to combat physical deconditioning and its comorbidities, providing patients with a valuable and novel experience. This systematic review aimed to conduct a search of relevant literature, to examine the effects of powered exoskeleton training on cardiovascular function and gait performance. Two electronic database searches were performed (2 April 2020 to 12 February 2021) and manual reference list searches of relevant manuscripts were completed. Studies meeting the inclusion criteria were systematically reviewed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. n = 63 relevant titles were highlighed; two further titles were identified through manual reference list searches. Following analysis n = 23 studies were included. Data extraction details included; sample size, age, gender, injury, the exoskeleton used, intervention duration, weekly sessions, total sessions, session duration and outcome measures. Results indicated that exoskeleton gait training elevated energy expenditure greater than wheelchair propulsion and improved gait function. Patients exercised at a moderate-intensity. Powered exoskeletons may increase energy expenditure to a similar level as non-exoskeleton walking, which may improve cardiovascular function more effectively than wheelchair propulsion alone.
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Affiliation(s)
- Damien Duddy
- Sports Lab North West, Letterkenny Institute of Technology, Port Road, Letterkenny, F92 FC93 Donegal, Ireland; (R.D.); (M.F.)
| | - Rónán Doherty
- Sports Lab North West, Letterkenny Institute of Technology, Port Road, Letterkenny, F92 FC93 Donegal, Ireland; (R.D.); (M.F.)
| | - James Connolly
- Department of Computing, Letterkenny Institute of Technology, Port Road, Letterkenny, F92 FC93 Donegal, Ireland;
| | - Stephen McNally
- No Barriers Foundation, Letterkenny, F92 TW27 Donegal, Ireland; (S.M.); (J.L.)
| | - Johnny Loughrey
- No Barriers Foundation, Letterkenny, F92 TW27 Donegal, Ireland; (S.M.); (J.L.)
| | - Maria Faulkner
- Sports Lab North West, Letterkenny Institute of Technology, Port Road, Letterkenny, F92 FC93 Donegal, Ireland; (R.D.); (M.F.)
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