筋萎縮性側索硬化症患者の装着型サイボーグHAL®介入効果における影響因子

Effect of Wearable Cyborg HAL Intervention in Patients with Amyotrophic Lateral Sclerosis and Predictors of Its Efficacy

要旨

目的：筋萎縮性側索硬化症（amyotrophic lateral sclerosis：ALS）患者における，装着型サイボーグHybrid Assistive Limb^®（HAL）の介入効果に影響する因子を検討した．

方法：対象は，当院に入院してHAL介入を行ったALS患者とし，1クールのHAL介入前後の2 minute walk distance（2 MD）の経時的変化と改善度を調査した．次に，患者属性およびHAL介入前の身体組成・栄養状態・呼吸機能・activities of daily living（ADL）の指標を用い，2 MD改善度に影響する因子を検討した．

結果：対象は13名であった．HAL介入前後の群内比較において，2 MDに有意な改善がみられた（介入前2 MD中央値［四分位数］−介入後2 MD中央値［四分位数］：36.0［32〜94.49］m−74.1［32.75〜117.8］m，p＝0.001）．2 MD改善度に影響する因子は，Barthel Index（BI）とphase angleが選択された（ANOVA：p＝0.004）．

結論：ALS患者のHAL介入による2 MD改善度には，介入前のBIとphase angleの影響が示唆された．ALS患者のHAL介入による2 MD改善度において，BIとphase angleが予測因子として有用である可能性を示した．

Objective：We identified the factors that influenced the effect of the Wearable Cyborg Hybrid Assistive Limb (HAL) in patients with amyotrophic lateral sclerosis (ALS).

Methods：The subjects were patients with ALS who were admitted to our hospital, and all of them underwent HAL intervention. The changes in 2-minute walking distance (2 MD) before and after 1 course of HAL intervention were investigated. Next, we examined the factors that influence the degree of 2 MD improvement using patient attributes and indices of body composition, nutritional status, respiratory function, and ADL (Activities of Daily Living) before HAL intervention.

Results：Thirteen subjects showed significant improvement in 2 MD measured before and after the HAL intervention (median 2 MD [quartile] before intervention−median 2 MD [quartile] after intervention：36.0 [32-94.49] m−74.1 [32.75-117.8] m, p＝0.001). The Barthel Index (BI) and phase angle were identified as the factors that influenced the degree of 2 MD improvement (ANOVA：p＝0.004).

Conclusion：The results suggest that the degree of improvement in 2 MD by HAL intervention in patients with ALS was the most affected by their BI and phase angle before the intervention. Thus, BI and phase angle may be useful as predictors in the degree of 2 MD improvement by HAL intervention in patients with ALS.