Physiological and perceptual demand of gait training on inpatient physiotherapists

ObjectiveTo describe the physiological and perceptual demand among physiotherapists delivering gait training interventions using usual care and overground robotic exoskeleton approaches for patients with neurological injuries during inpatient rehabilitation.DesignSingle-centre, prospective observational study.SettingInpatient Rehabilitation Hospital.ParticipantsPhysiotherapists trained in neurorehabilitation.InterventionPhysiotherapists conducted two gait training sessions (one usual care and one overground robotic exoskeleton) while physiological and perceptual demand was assessed.Main measuresPhysiological (oxygen consumption, metabolic equivalents and heart rate) and perceptual demand were measured using a wearable metabolic system and the National Aeronautics and Space Administration Task Load Index, respectively.ResultsPhysiotherapists (n = 4) were female, median (min-max) age = 35(34-44) years, non-Hispanic, 50% White, with 11(5-19) years of experience. Physiological demand was lower in overground robotic exoskeleton than usual care in oxygen consumption [13.5(11.3-15.3) versus 16.4(13.5-18.6) millilitres of oxygen/minute/kilogramme of body mass], metabolic equivalents [3.9(3.2-4.4) versus 4.7(3.8-5.3)], average heart rate [111(90-136) versus 119(103-145) beats per minute], peak heart rate [121(101-149) versus 149(116-162) beats per minute] and recovery heart rate [113(88-148) versus 123(105-161) beats per minute]. Perceptual demand was lower in overground robotic exoskeleton than usual care in mental [7(5-16) versus 12(6-17)], physical [10(8-12) versus 16.5(14-21)] and temporal demand [3.5(1-9) versus 12.5(2-16)], performance [5(3-16) versus 11(4-17)], effort [9(6-15) versus 16.5(13-17)] and frustration [3(1-7) versus 5.5(3-8)].ConclusionsDelivery of overground robotic exoskeleton gait training was associated with lower physiological and perceptual demand compared to usual care gait training in patients with neurological injuries during inpatient rehabilitation. Identifying modalities with low demand may reduce physiotherapist burnout and workplace injuries.