Rehabilitation in progressive supranuclear palsy: Effectiveness of two multidisciplinary treatments

<div><p>Background</p><p>to date, there are no medical or surgical treatments for progressive supranuclear palsy (PSP). It is possible to speculate that patients with PSP could benefit from rehabilitative treatments designed for Parkinson’s disease, including the use of robot-assisted walking training.</p><p>Objective</p><p>to evaluate whether the use of the robotic device Lokomat® is superior in PSP patients to the use of treadmill with visual cues and auditory feedbacks (treadmill-plus) in the context of an aerobic, multidisciplinary, intensive, motor-cognitive and goal-based rehabilitation treatment (MIRT) conceived for Parkinsonian patients.</p><p>Methods</p><p>we enrolled twenty-four PSP patients. Twelve subjects underwent a 4-week MIRT exploiting the use of the treadmill-plus (MIRT group). Twelve subjects underwent the same treatment, but replacing the treadmill-plus with Lokomat® (MIRT-Lokomat group). Subjects were evaluated with clinical and functional scales at admission and discharge. The primary outcomes were the total PSP Rating Scale (PSPRS) score and its “limb” and “gait” sub-scores. Secondary outcomes were Berg Balance Scale (BBS), Six Minutes Walking test (6MWT) and the number of falls.</p><p>Results</p><p>total PSPRS, PSPRS-gait sub-score, BBS, 6MWT and number of falls improved significantly in both groups (p ≤ 0.003 all, except 6MWT, p = 0.032 and p = 0.018 in MIRT-Lokomat and MIRT group respectively). The PSPRS-limb sub-score improved significantly only in the MIRT group (p = 0.002). A significant difference between groups was observed only for total PSPRS, indicating a slightly better improvement for patients in the MIRT group (p = 0.047). No differences between groups were revealed for the other outcomes, indicating that the effect of rehabilitation was similar in both groups.</p><p>Conclusions</p><p>Lokomat<b>®</b> training, in comparison with treadmill-plus training, does not provide further benefits in PSP patients undergoing MIRT. Our findings suggest the usefulness of an aerobic, multidisciplinary, intensive, motor-cognitive and goal-based approach for the rehabilitation of patients suffering from such a complex disease as PSP.</p><p>Trial Registration</p><p>This trial was registered on ClinicalTrials.gov, <a href="https://clinicaltrials.gov/ct2/show/NCT02109393" target="_blank">NCT02109393</a>.</p></div

CONSORT flow diagram.

<p>CONSORT flow diagram.</p

Demographic and clinical characteristics of patients assigned to MIRT group and MIRT-Lokomat group.

<p>Reported p-values are computed by the Chi-square test for the variable Sex, by unpaired t-test for age, LED, weight, height, disease duration and by the Mann–Whitney U test for all the other variables. Data are reported as median (lower quartile, upper quartile) or mean±SD for non-normally and normally data respectively and as number (frequency percentage) for discrete variables.</p

Baseline and end of treatment values of outcome variables for both groups of patients.

<p>Reported p-values are computed by the Wilcoxon signed rank test. Data are reported as median (lower quartile, upper quartile).</p

Difference (discharge-admission) of the outcome variables for MIRT+Lokomat group and MIRT group and effect size.

<p>Reported p-values are computed by the Mann–Whitney U test.</p