Can technology-based gait training result in relevant changes of ambulatory function in people with chronic, neurological diagnoses? A longitudinal, cohort study

Abstract

Objectives To determine whether a six-months technology-based gait training results in relevant changes of ambulatory function in a chronic stage after a neurological event. Further, changes in quality of life will be assessed as well as the willingness to pay for technology-based gait training. Design Single-center, longitudinal cohort study. Setting One outpatient center specialized in neurological rehabilitation. Participants Adults with a chronic neurological diagnosis resulting in residual gait impairments. Intervention Six month of technology-based gait training (with Lokomat, Andago, or C-Mill) with a minimal number of trainings of 10 per month. Primary & secondary outcome measures Walking performance assessed with the 10-meter walk test, 6-minute walk test and functional ambulation category; quality of life assessed with the EQ-5D-3L and WHODAS 2.0; predicted market share and willingness to pay assessed with a choice-based conjoint analysis survey and direct question. Results 27 participants completed three months while 20 completed six months of training. Comparing variables at baseline (BL) and after three (M3) and six (M6) months of training, both the walking speed in the 10-meter walk test (BL: 0.46m/s, M3: 0.54 m/s M6: 0.57 m/s) and the distance covered in the 6-minute walk test (BL: 149m, M3: 155m, M6: 159m) showed improvements that were below the clinically relevant change. The quality of life did not indicate a change. The direct willingness to pay was at CHF 80 which resulted in an estimated market share of 55% based on the conjoint analysis. Conclusion The observed, small changes in ambulatory function in patients with chronic, neurological impairments and the willingness to pay indicates the need to provide technology-based gait training in an outpatient setting.