Effects of robotic-assisted gait training on the central vascular health of individuals with spinal cord injury: A pilot study.

Objective: To investigate the effect of a short-term, robotic-assisted (exoskeleton) gait training (RGT) program on central and peripheral hemodynamic measures in patients with spinal cord injury (SCI).Design: Parallel group, non-randomized trial with before (baseline) and after (follow-up) assessments.Setting: Single-center, community-based neuro-physiotherapy practice.Participants: Twelve individuals with SCI (ASI A to C).Interventions: Participants completed either a 5-day RGT program plus physiotherapy (n = 6), or a usual care physiotherapy only program (control group; n = 6). The RGT program consisted of daily 60-min physiotherapy and 90-min of RGT. Outcome measures were measured before and after the rehabilitation program.Main outcome measure(s): The primary outcome measure was arterial wave reflection (Augmentation index [AIx]), with central and peripheral blood pressures also reported. Data are presented as mean (SD) and effect sizes (partial eta squared; η2p).Results: There was a significant reduction in AIx (30 ± 18-21 ± 15%; η2p=0.75) and mean arterial pressure (89 ± 11-82 ± 10 mmHg; η2p=0.47) following completion of the RGT program (both P < 0.05). There were no changes in these measures for the control group. Although not significantly different, medium to large effects were observed in favor of RGT for all other central and peripheral measures (η2p=0.06-0.21), except for heart rate and pulse pressure (η2p<0.04).Conclusions: RGT using an exoskeleton is a promising therapy for improving cardiovascular health in patients with SCI. Specifically, this study indicates decreased arterial wave reflection and supports the need for larger randomized controlled trials.Trial Registration: Clinical trials Registry (https://clinicaltrials.gov/; NCT03611803).

Health professionals: how do they assess new medicines?

OBJECTIVE: To identify the types of information used by health professionals when assessing a new medicine, and to discover whether measures of clinical effectiveness and cost-effectiveness are understood and used. METHOD: A cross-sectional survey of 56 health professionals was undertaken in a tertiary hospital in New Zealand. Respondents were consultants, registrars, house-surgeons, pharmacists, and specialist nurses MAIN OUTCOME MEASURES: Health professionals' opinions on clinical and cost information required for assessing a new medicine; their ability to calculate measures of risk; and their ability to define clinical effectiveness, cost-effectiveness and types of economic analysis. RESULTS: Thirty-four percent of respondents considered journals and research to be the most accurate sources of information when assessing a new medicine. Efficacy, safety, contraindications and side-effects were the most important information sought. In total, 93% gave an acceptable definition of clinical effectiveness, and 38% of cost-effectiveness. The majority of each profession (except specialist nurses) could calculate relative risk reduction (RRR) and absolute risk reduction (ARR) but fewer could calculate numbers needed to treat (NNT). Eighty-four percent of respondents felt that cost affected their assessment of a new medicine. Less than a quarter of respondents could define each type of economic analysis. Consultants and pharmacists appeared to have the best knowledge of economic analysis. CONCLUSION: Efficacy, safety, contraindications and side-effects were the most important information sought when assessing a new medicine. Health professionals' knowledge of clinical effectiveness was greater than their knowledge of cost-effectiveness. Consultants and pharmacists appeared to have the best knowledge of economic analysis.