This clinical trial aims to collect evidence on the clinical benefits and the socioeconomic impact of integrating a novel wearable powered lower-limb exoskeleton for gait rehabilitation in acute/subacute spinal cord injured individuals and to evaluate the efficiency of this technology to the current standard of care in the Spanish Healthcare System (SNS).. The main questions it aims to answer are: * Is robotic therapy for gait rehabilitation more effective and efficient than conventional therapy? * Does robotic therapy for gait rehabilitation reduce the burden on healthcare professionals and caregivers? * Does robotic therapy for gait rehabilitation reduce direct healthcare costs? * Does robotic therapy for gait rehabilitation reduce intervention-related costs? Researchers will compare a novel wearable powered lower-limb exoskeleton for gait rehabilitation to conventional therapy to see if the robotic exoskeleton is more effective and efficient in improving clinical benefits and to assess if it reduces the burden of healthcare professionals and caregivers, as well as healthcare and intervention-related costs. Participants will: * Be randomized on a 1:1 basis to receive rehabilitation treatment with either the robotic exoskeleton or conventional therapy for gait recovery, 3 times a week on non-consecutive days for 8 weeks (24-session program). * Undergo a pre- and post-intervention assessment of clinical, functional, physiological, psychological, and socioeconomic variables. * Have a follow-up visit 2 months after the end of the treatment.
Participants will be recruited from among patients admitted to the institutions involved in the project: Vall d'Hebron University Hospital (HVH) through its research institute (VHIR) and the National Hospital for Paraplegics of Toledo (HNP), through its research foundation (FHNP). After checking the inclusion and exclusion criteria, informing the patient and signing the consent, they will be randomly distributed between the control group (CG) and the intervention group (IG). Open random parallel groups. The IG will receive rehabilitation treatment with the ABLE Exoskeleton, while the CG will receive conventional therapy for gait rehabilitation. The latter includes joint mobilizations, strengthening of paretic muscles and re-education of walking with parallel bars, making use of the technical aids and orthoses required by the patient (KAFOs, crutches and walkers). For both groups, participation in the study is based on a baseline visit, the 24-session rehabilitation treatment (including mid-training and end-training assessments at 12-session and 24-session, respectively) and a follow-up visit two months after the end of the treatment. Caregiver overload will also be assessed at baseline visit, after patient's treatment and at the follow-up visit two months after patient treatment.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
80
Participants will receive a 24-session rehabilitation treatment program with the ABLE Exoskeleton, 3 times a week for up to 8 weeks
Participants will receive a 24-session conventional therapy program for gait rehabilitation, 3 times a week for up to 8 weeks. Conventional therapy includes joint mobilizations, strengthening of paretic muscles and re-education of walking with parallel bars, making use of the technical aids and orthoses required by the patient (KAFOs, crutches and walkers).
Hospital Nacional de Parapléjicos
Toledo, Castille-La Mancha, Spain
NOT_YET_RECRUITINGHospital Universitario de Vall d'Hebron
Barcelona, Catalonia, Spain
RECRUITINGChange in Walking ability
The walking ability will be assessed using the Walking Index Spinal Cord Injury (WISCI) II which evaluates the amount of physical assistance needed, as well as devices required, for walking following paralysis that results from Spinal Cord Injury (SCI). The WISCI II score ranges from 0 to 20 (0: the individual is unable to walk, 20: the individual walks without assistance or devices)
Time frame: Baseline , end of treatment (at 8 weeks), and follow-up (2 months after end of treatment)
Change in Balance
The balance will be assessed by the time taken to complete the Timed-Up-and-Go (TUG) test which evaluates mobility and balance.
Time frame: Baseline, mid-training (at 4 weeks), and end of treatment (at 8 weeks)
Change in Gait speed
The gait speed will be assessed by the time taken to complete the 10 meter Walk Test (10mWT) which evaluates walking speed in meters per second over a short duration.
Time frame: Baseline, mid-training (at 4 weeks), and end of treatment (at 8 weeks)
Change in Lower Extremity Motor Score (LEMS)
The Lower Extremity Motor Score (LEMS) evaluates motor function on a scale of 0 (no motor function) to 5 (full motor function) for 5 lower extremity muscle groups with a 50-point maximum (25 per side).
Time frame: Baseline, mid-training (at 4 weeks), end of treatment (at 8 weeks), and follow-up (2 months after end of treatment)
Change in Trunk control
The trunk control will be assessed using the Trunk Assessment Scale for Spinal Cord Injury (TASS). The TASS consists of nine sitting tasks without upper-limb support: one task is static, and the other eight tasks are dynamic. Each item is assigned a score of 0-2, 0-4, or 0-6 for a total score of 44, with higher scores indicating better trunk function.
Time frame: Baseline, end of treatment (at 8 weeks), and follow-up (2 months after end of treatment)
Change in Endurance
Endurance will be assessed by the distance (in meters) walked during the 2-Minute Walk Test (2MWT), which evaluates walking capacity and functional mobility.
Time frame: Baseline, mid-training (at 4 weeks), and end of treatment (at 8 weeks)
Change in Endurance
Endurance will be assessed by the distance (in meters) walked during the 6-Minute Walk Test (6MWT), which evaluates walking capacity and functional mobility.
Time frame: Baseline, mid-training (at 4 weeks), and end of treatment (at 8 weeks)
Change in Level of Exertion
Perceived exertion associated with the walking test (2MWT/6MWT) will be assessed using the Borg Rating of Perceived Exertion Scale, a self-report scale ranging from 0 to 10. A score of 0 indicates no exertion, and 10 indicates maximal exertion. Higher scores represent greater perceived exertion.
Time frame: Baseline, mid-training (at 4 weeks), and end of treatment (at 8 weeks)
Change in Gait pattern
The gait pattern and compensatory movements will be assessed through kinetic and kinematic gait parameters collected using a 3-D gait analysis system. The Gait Deviation Index for SCI (SCI-GDI) will be calculated to evaluate the difference between the patient' gait pattern compared to the reference gait pattern. The SCI-GDI score typically ranges from 0 to 100, with 100 representing a normal gait pattern.
Time frame: Baseline, mid-training (at 4 weeks), end of treatment (at 8 weeks), and follow-up (2 months after end of treatment)
Change in Bladder and Bowel function
Bladder and bowel function will be assessed using the International Standards to document Autonomic Function following SCI (ISAFSCI), which identifies which autonomic functions (e.g., bladder, bowel) are intact, impaired, or lost.
Time frame: Baseline, end of treatment (at 8 weeks), and follow-up (2 months after end of treatment)
Change in Bladder and Bowel function
Bowel function will also be assessed using the Neurogenic Bowel Dysfunction score (NBD score), a self-report questionnaire. The total NBD score ranges from 0 to 47, with higher scores indicating more severe dysfunction.
Time frame: Baseline, end of treatment (at 8 weeks), and follow-up (2 months after end of treatment)
Change in Bone density
The Bone density will be assessed through analytical control, 24-hour urine, and dual-energy X-ray absorptiometry (DEXA) scan in the spine, hip and knee.
Time frame: At baseline and end of treatment (at 8 weeks)
Change in Cardiovascular function
The cardiovascular function will be asssessed by an arm ergometry test, which is a test that measures the heart's response to physical exertion. The maximum heart rate (HR) will be documented.
Time frame: At baseline and end of treatment (at 8 weeks)
Change in Respiratory function
The respiratory function will be assessed by a simple spirometry, which is a test that measures the volume of air exhaled in one second (FEV1) and the total volume of air exhaled forcefully (FVC).
Time frame: Baseline, end of treatment (at 8 weeks), and follow-up (2 months after end of treatment)
Pain reduction
The reduction in pain will be assessed using International Spinal Cord Injury Pain Basic Data Set (ISCIPBDS) which is used to document the interference of pain with physical and emotional function and sleep, probable pain diagnosis, location, intensity and duration. Each value is scored on a 0 to 10 numerical rating scale, where 0 represents no pain and 10 represents the worst pain imaginable.
Time frame: From baseline to follow-up (at 2 months after the end of treatment)
Change in Spasticity
The spasticity in the lower limbs will be assessed using both the Spinal Cord Assessment Tool for Spastic Reflexes (SCATS) score, which evaluates three types of spastic motor behaviors in SCI patients - clonus, flexor spasms, and extensor spasms, as well as the Modified Ashworth Scale (MAS). SCATS total score (0-9; higher = worse outcome)
Time frame: Baseline, end of treatment (at 8 weeks), and follow-up (2 months after the end of treatment)
Change in Functional independence
The functional independence will be assesed using the Spinal Cord Independence Measure III (SCIM III) which is a patient-reported outcome measure that evaluates three main domains: self-care, respiration and sphincter management, and mobility. The SCIM III score is calculated on a scale of 0-100, with 0 indicating complete dependence and 100 indicating complete independence.
Time frame: Baseline, end of treatment (at 8 weeks), and follow-up (2 months after the end of treatment)
Change in Quality of Life
Quality of life will be assessed using the 5-level EQ-5D version (EQ-5D-5L), a standardized instrument for measuring generic health status. Ranging from 1 (best possible health) to values less than 0.
Time frame: At baseline and end of treatment (at 8 weeks)
Change in Quality of Life
Emotional well-being will be assessed using the Hospital Anxiety and Depression Scale (HADS), which measures anxiety and depression. Score on HADS subscales (0-21 per subscale; with higher numbers indicating a greater level of anxiety or depression)
Time frame: At baseline and end of treatment (at 8 weeks)
Change in Quality of Life
Motivation will be assessed using the interest/enjoyment subscale of the Intrinsic Motivation Inventory (IMI). Interest/Enjoyment score on IMI subscale (1-7; where 1 represents "Not at all true" and 7 represents "Very true")
Time frame: At baseline and end of treatment (at 8 weeks)
Burden of healthcare professionals
The burden on healthcare professionals will be assessed using the NASA Task Load Index (NASA-TLX), a self-report questionnaire to assess work load on five 7-point scales. NASA-TLX scores can range from 0 to 100, where a higher score generally indicates a higher workload
Time frame: At end of treatment (8 weeks)
Change in Burden of the caregiver
The caregiver burden will be assessed using the Zarit Burden Interview, a 22-item self-report questionnaire which total score ranges from 0 to 88. The higher the value, the higher the caregiver burden.
Time frame: Baseline, end of treatment (at 8 weeks), and follow-up (2 months after the end of treatment)
Change in Direct healthcare costs
The medical costs including hospitalization days, transportations, specialists consultations, rehabilitation services, emergency room visits, and hospital admissions will be calculated.
Time frame: Baseline (Day 0), end of treatment (8 weeks), and follow-up (16 weeks)
Intervention-related costs
The costs associated to the rehabilitation sessions, treatment, and equipment during the intervention period will be calculated.
Time frame: At the end of treatment (8 weeks)
Change in the productivity losses
Variation in indirect costs for patient and caregiver, associated with reduced work capacity, absenteeism, or early retirement, as a result of the intervention.
Time frame: Baseline, end of treatment (at 8 weeks), and follow-up (2 months after the end of treatment)
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