Cueing training in the home improves mobility in Parkinson's disease

QuestionDoes a 3-week, home-based cueing program improve gait, gait-related activity, and health-related quality of life in people with Parkinson's disease (PD)?DesignA multicentre, single-blinded randomised crossover trial.SettingUniversity medical centres in the UK, Belgium, and The Netherlands.Patients153 patients with PD aged between 41 and 80 years and in Hoehn and Yahr stage II–IV were randomly allocated to an ‘early’ or ‘late’ intervention group. Subjects in the late group were put on a 3-week waiting list, without intervention, followed immediately by three weeks of cueing training. The order of the 3-week periods was reversed in the early group. Both groups underwent a follow-up period of 6 weeks without training.InterventionsThe cueing program was delivered at home and consisted of nine treatment sessions of 30 minutes. Patients were trained with their preferred cueing modality: auditory, visual (light flashes), or somatic-sensory (vibrations). Cueing strategies were trained during a variety of tasks and environmental situations (indoor and outdoor), aiming to improve step length and walking speed, prevent freezing episodes and improve balance, by correcting the temporal aspects of gait.OutcomesPosture and gait scores (PG scores) measured at 3, 6, and 12 weeks were the primary outcomes. The PG scores consisted of a composite score of gait and balance based on items of the Unified Parkinson's Disease Rating Scale. Secondary outcomes included specific measures of gait, freezing and balance, functional activities, quality of life, and carer strain.Main resultsSmall but significant (p < 0.05) improvements were found after intervention of 4.2% on the PG scores, gait speed (5 cm/sec), step length (4 cm), timed balance tests, and the confidence to carry out functional activities as measured with the Falls Efficacy Scale (3.7%). Severity of freezing was reduced by 5.5% in freezers only.ConclusionCueing training in the home improves mobility in patients with PD

The effects of physical therapy in Parkinson's disease: A research synthesis

Objective: To present a critical review and meta-analysis of studies evaluating the effects of physical therapy in patients suffering from Parkinson's disease (PD), in terms of neurologic signs, activities of daily living (ADLs), and walking ability. Data Sources: Articles published from 1966 to May 1999 were compiled by means of MEDLINE, Cochrane register of controlled trials, and CINAHL using combinations of the key words Parkinson's disease, exercise, exercise therapy, physical therapy, and group training. References presented in relevant publications were also examined. Articles written in English, German, or Dutch were included. Study Selection: Studies had to meet the following selection criteria: (1) patients with PD were included in the intervention study, (2) the effects of physical therapy (PT) were evaluated, (3) the study could be classified as true or quasi-experiment, and (4) the study was published in a journal or book. Data Extraction: Two reviewers assessed independently the methodologic quality of the data of each included study. One reviewer extracted relevant meta-analysis data. Data Synthesis: For each outcome measure the estimated effect size and the summary effect size (SES) were calculated, using fixed (ie, Hedges's g) and random effects models. The meta-analysis resulted in a significant homogeneous SES with regard to ADLs (.40; confidence interval [CI] = .17-.64) and stride length (.46; CI = .12-.82). The SES with regard to walking speed showed a significant heterogeneous SES, which remained significant after applying a random effects model (.49; CI = .21-.77). The SES with regard to neurologic signs was not significant (.22; CI =-.08 to .52). The small number Of studies included and the shortcomings of the methodologic quality of these studies, however, bias the results of the present study. Conclusions: The results of the present research synthesis support the hypothesis that Parkinson patients benefit from PT added to their standard medication