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INTRODUÇÃO: Na Esclerose Múltipla (EM) a marcha é frequentemente afectada pela incapacidade e o número de doentes a precisar de ajuda na marcha nos 15 anos após o inicio da doença pode atingir 50%. O treino em tapete rolante (TTR), incluindo o de suspensão parcial do peso corporal (TTRcS), tem sido integrado, com resultados positivos, em programas de reabilitação de doentes com EM. Parece ser uma intervenção dependente da actividade com potencial para reduzir a incapacidade da marcha. OBJECTIVO: Investigar, quanto à evolução funcional da marcha, se o programa TTRcS é ou não mais eficaz que o TTRsS em doentes com EM. MÉTODOS: Estudo experimental, prospectivo, com aleatorização e crossover, comparando a intervenção do TTRcS com o TTRsS em 12 doentes com EM de EDSS 4.0 a 6.0, que receberam 3 sessões semanais de treino, durante 3 semanas em cada fase, com o total de 2 fases de intervenção. Os instrumentos de recolha de dados usados foram as escalas 6MWT, T25FW, TUG, MFIS e EQ-5D. RESULTADOS: Verificaram-se nos parâmetros referentes à velocidade (T25FW) melhoria significativa (p=0,02) no TTRcS; na mobilidade (TUG) melhoria significativa (p=0,04) no TTRcS; percepção de fadiga (MFIS) melhoria significativa no score total (0,04) e na dimensão física (0,04). Quanto à distância percorrida (6MWT): melhoria mas sem resultados estatisticamente significativos. Os resultados do impacto na qualidade de vida (EQ-5D) não são conclusivos. CONCLUSÕES: Encontrámos suporte para a hipótese de o TTRcS ser mais eficaz quando comparado com o TTRsS para a melhoria da marcha em doentes com EM com grau de incapacidade da EDSS 4.0 a 6.0. A utilização do TTRcS parece permitir alcançar mais rapidamente o potencial de recuperação da marcha nos doentes. A sua aplicação clínica resulta em benefícios e deve ser mais bem caracterizada antes de ser aplicada na prática clínica. Recomenda-se investigação mais aprofundada sobre o TTRcS.
BACKGROUND: In multiple sclerosis (MS) walking is frequently impaired and the number of patients needing help for walking may reach 50%, fifteen years after the start of the disease. Treadmill training (TT), body weight supported treadmill training (BWSTT) included, has been incorporated with positive results in rehabilitation programmers for MS patients. It seems to be an intervention dependent on activity with potential to reduce gait impairment. OBJECTIVE: To find if BWSTT is more effective than TT for functional gait improvement in MS patients. METHODS: Randomized, controlled, prospective study, with crossover design, compares BWSTT and TT intervention in a sample in 12 MS patients with EDSS 4.0 to 6.0, who received 3 weekly training sessions, over 3 weeks in each phase, in two intervention phases. Measurement outcome tools were: 6MWT, T25FW, TUG, MFIS and EQ-5D. RESULTS: Velocity parameters measured by 25FWT showed significant improvement (p=0,02) in BWSTT; mobility (TUG) significant improvement (p=0,04) in BWSTT; fatigue perception (MFIS) significant improvement in total (p=0,04) and physical dimension scores (p=0,04) with BWSTT. Improvement in distance covered in 6MWT, but with no statistically significant differences. Impact on quality of life (EQ-5D): no conclusive results. CONCLUSIONS: We found some support for the hypothesis that BWSTT has better results when compared with TT to improve gait in MS patients with EDSS 4.0 to 6.0. BWSTT seems to allow gains faster in the recovery potential of patients. Its clinical use is beneficial and it should be better characterized before clinical application. More research on BWSTT is recommended.
BACKGROUND: In multiple sclerosis (MS) walking is frequently impaired and the number of patients needing help for walking may reach 50%, fifteen years after the start of the disease. Treadmill training (TT), body weight supported treadmill training (BWSTT) included, has been incorporated with positive results in rehabilitation programmers for MS patients. It seems to be an intervention dependent on activity with potential to reduce gait impairment. OBJECTIVE: To find if BWSTT is more effective than TT for functional gait improvement in MS patients. METHODS: Randomized, controlled, prospective study, with crossover design, compares BWSTT and TT intervention in a sample in 12 MS patients with EDSS 4.0 to 6.0, who received 3 weekly training sessions, over 3 weeks in each phase, in two intervention phases. Measurement outcome tools were: 6MWT, T25FW, TUG, MFIS and EQ-5D. RESULTS: Velocity parameters measured by 25FWT showed significant improvement (p=0,02) in BWSTT; mobility (TUG) significant improvement (p=0,04) in BWSTT; fatigue perception (MFIS) significant improvement in total (p=0,04) and physical dimension scores (p=0,04) with BWSTT. Improvement in distance covered in 6MWT, but with no statistically significant differences. Impact on quality of life (EQ-5D): no conclusive results. CONCLUSIONS: We found some support for the hypothesis that BWSTT has better results when compared with TT to improve gait in MS patients with EDSS 4.0 to 6.0. BWSTT seems to allow gains faster in the recovery potential of patients. Its clinical use is beneficial and it should be better characterized before clinical application. More research on BWSTT is recommended.
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Esclerose múltipla Incapacidade da marcha Exercício Treino de tapete rolante Multiple sclerosis Exercise Treadmill training