SENSORY SUBSTITUTION FOR ORTHOPAEDIC GAIT REHABILITATION: A SYSTEMATIC REVIEW AND META-ANALYSIS FOR CLINICAL PRACTICE GUIDELINE DEVELOPMENT

P. Lynch¹, K. Monaghan¹, P. Broderick¹

¹Atlantic Technological University Sligo, School of Science, Sligo, Ireland

Background: Globally, approximately 1.7 billion people are affected by orthopaedic conditions each year. Orthopaedic conditions are often perceived as most disabling when they affect an individual’s gait. Sensory Substitution is a biofeedback intervention modality in which one sensory system is used to supplement environmental information normally gathered by another sense. Sensory Substitution devices have previously been proven to be feasible and effective interventions for balance and gait outcomes in neurological patient populations. No previous literature has explored and reported combined feasibility and effectiveness outcomes of Sensory Substitution devices in orthopaedics.

Purpose: The purpose of this study was to present an evidence-based review and report if Sensory Substitution devices are feasible and effective interventions on gait outcomes in orthopaedic patient populations.

Methods: This Systematic Review and Meta-Analysis was conducted according to the PRISMA-P protocol. PubMed, the Cochrane Library, Web of Science and PEDro were searched for relevant published literature.

Results: Nine randomised controlled trials and three crossover trials investigating the effectiveness of Sensory Substitution supplemented gait training were identified and included participants with a variety of orthopaedic conditions. Most included studies were determined as high quality. The most frequent risk of bias issue identified was related to blinding, due to not being specified or being single blinded. Meta-Analyses revealed evidence in favour of feasibility and a global positive statistical and clinical effect of the interventions in improving measures of gait speed, weight-bearing control, measures of functionality and subjective self-reporting. The largest clinical effects of the interventions were found in favour of improving weight-bearing control, functionality and self-report measures. Meta-Analyses also revealed non-significant effects of the interventions in pain management and retention of gait speed. Negatively reinforced Sensory Substitution biofeedback (feedback provided when not achieving desired target) was statistically and clinically effective, whilst positively reinforced biofeedback (feedback provided when achieving desired target) was not. Pooled data from statistically and clinically effective interventions revealed a mean total duration of interventions of 300 minutes over a total of 5 weeks. Therefore, the authors recommend gait training supplemented by Sensory Substitution devices is conducted for 20 minutes per day, 3 days per week for 5 weeks.

Conclusions: For orthopaedic patient populations to improve gait speed, weight-bearing control, functionality and self-report measures, the authors recommend a Sensory Substitution supplemented gait training programme with negative biofeedback on performance. The intervention should be undertaken for 20 minutes per day, 3 days per week for 5 weeks.

Implications: Gait recovery is highly associated with prognosis of functional outcomes and risk of further health complications in orthopaedics. Clinical intervention guidelines are important to guide structure, volume and considerations to ensure appropriate training. Implementing policies to improve orthopaedic gait rehabilitation have potential for both significant epidemiological and economic benefit. The findings of this research suggest the consideration of introducing Sensory Substitution device based rehabilitation to gait training programmes in orthopaedics.

Funding acknowledgements: The authors disclose that no financial support was provided for this study.

Keywords:
Sensory Substitution
Orthopaedic
Meta-Analysis

Topics:
Orthopaedics
Innovative technology: information management, big data and artificial intelligence

Did this work require ethics approval? No

Reason: Ethical approval was not required as this study was a Systematic Literature Review and Meta-Analysis.