Date of Award

2-23-2009

Document Type

Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Albert Lo

Abstract

The purpose of this pilot crossover study is to describe data on the effect of body-weight supported treadmill training (BWSTT) on quality of life (QoL) for people with MS. Thirteen men and women with gait impairment secondary to MS underwent two blocks of 6 biweekly BWSTT sessions - one block with a robot-driven gait orthotic and one block withoutwith a six-week washout period between the two training blocks. Subjects were stratified as high or low impairment and then randomized to a treatment order: robot-assisted then treadmill alone (RT) or treadmill alone then robot-assisted (TR). Quality of life was assessed before and after both training blocks by the Fatigue Severity Scale (FSS), the ten-scale Multiple Sclerosis Quality of Life Inventory (MSQLI), and a single life satisfaction (LS) item. The effect of treatment type was evaluated for clinical meaningfulness by standardized effect sizes and for statistical significance by repeated measures ANOVA comparing change during robot-assisted training blocks to change during unassisted training blocks. Additionally, standardized effect sizes and Student t-tests comparing baseline to endpoint data were used evaluate the overall effect on quality of life of both types BWSTT combined. Comparison of the two treatment types showed mixed results with slightly larger effect sizes on the scales favoring robot-assisted training. Overall change from baseline to the end of the second training block showed improvement in all QoL measures. Improvements were significant on scales assessing physical well being (PCS; p=0.025), fatigue (MFIS; p=0.020), pain (PES; p=0.029), perceived cognitive function (PDQ-5; p=0.018) and life satisfaction (LS; p=0.020). While this pilot study was not adequately powered to demonstrate a significant difference between robot-assisted and unassisted BWSTT on quality of life outcomes, its results suggest that robot-assisted BWSTT may provide some advantage over unassisted BWSTT. More generally, this study shows that both types of BWSTT may lead to diverse benefits in quality of life for people with gait function secondary to MS.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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