The effects of a multi-system balance training programme on improving balance, gait and functional performance in people with Parkinson's disease : a randomized controlled trial with 12-month follow-up

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The effects of a multi-system balance training programme on improving balance, gait and functional performance in people with Parkinson's disease : a randomized controlled trial with 12-month follow-up

 

Author: Yu Wong, Sin Kwan Irene
Title: The effects of a multi-system balance training programme on improving balance, gait and functional performance in people with Parkinson's disease : a randomized controlled trial with 12-month follow-up
Degree: Ph.D.
Year: 2016
Subject: Parkinson's disease -- Exercise therapy.
Parkinson's disease -- Patients
Equilibrium (Physiology)
Falls (Accidents) -- Prevention
Hong Kong Polytechnic University -- Dissertations
Department: Dept. of Rehabilitation Sciences
Pages: xxx, 523 pages : color illustrations
Language: English
InnoPac Record: http://library.polyu.edu.hk/record=b2925551
URI: http://theses.lib.polyu.edu.hk/handle/200/8702
Abstract: Background. Previous studies have demonstrated that exercise interventions can improve balance, gait, functional and motor performance in people with Parkinson's disease (PD), but most training did not target all balance domains and was conducted mainly indoors. Early intervention is essential for improving postural stability and avoiding fall-related injuries. Most clinical trials included individuals with PD at moderate stage and had sustained recurrent falls. No study has targeted non-fallers and single fallers, although they had worse balance performance than healthy subjects. Objectives. Our primary aim is to investigate the short- and long-term effects of a multi-system blended indoor and outdoor (BIO) balance training programme on balance performance. Our secondary aim is to investigate the short- and long-term effects of a multi-system BIO balance training programme on gait, functional and motor performance, balance confidence, quality of life as well as preventing falls and fall-related injuries in people with PD. Methods. Eligible subjects with PD were randomly assigned to an eight-week (one 2-hour session per week) multi-system balance training programme (EXP, N=41) group or active control (CON, N=43) group supervised by physiotherapists. The EXP subjects underwent training for four weeks indoors, followed by four weeks outdoors. Indoor exercises included multi-system postural control strategies such as postural re-education and flexibility exercises, strength and functional training, Balance Dance, modified Wing Chun and Square Stepping Exercise. Outdoor exercises included perturbation-based training, fall-prone functional tasks and dual-task activities in the community. The CON subjects received 8-week upper limb training in sitting at the same dosage. Both groups were instructed to perform 3 hours of home exercise weekly during training period and for duration of 6 months after completion of training. The primary outcome measures included the BESTest total and subsection scores. The secondary outcome measures included gait speed, timed-up-and-go (TUG) time, dual-task timed-up-and-go (dual-task TUG) time, functional reach (FR) distance, five-time-sit-to-stand (FTSTS) time, one-leg-stance (OLS) time, Movement Disorder Society sponsored Unified Parkinson's Disease Rating Scale (MDS-UPDRS) III scores, Chinese version of Activities-specific Balance Confidence (ABC-C) score, and Parkinson's disease quality of life (PDQ-39) total and subscale scores. The fall-related outcomes included the ratio of non-fallers to fallers, the ratio of non-injurious fallers to injurious fallers, falls and injurious fall rates, and times to the first falls and injurious falls. All outcomes were assessed before training (Pre), after completing 4-week intervention (Post4week), immediately after 8-week intervention (Post8week), and at six months (FU6m) and twelve months (FU12m) after treatment completion.
Results. After 4-week training, EXP group showed significantly greater improvements from baseline than CON group for the BESTest total and subsection scores, FR distance, FTSTS time, MDS-UPDRS III score and PDQ-39 bodily discomfort subscale score (all p < 0.05). Immediately after 8-week training, EXP group showed significantly greater improvements from baseline than CON group for the BESTest total and subsection scores, FR distance, FTSTS time, OLS time, gait speed and dual-task TUG time (all p < 0.05). At both FU6m and FU12m, EXP group showed significantly greater improvements from baseline than CON group for the BESTest total and subsection scores, dual-task TUG time, FR distance, FTSTS time and OLS time (p <0.05). The number of injurious fallers was significantly lower in the EXP group at 6-month and 12-month follow-ups. Conclusion. The EXP subjects outperformed CON subjects for the BESTest total and subsection scores immediately after treatment completion and at both 6-month and 12-month follow-ups. The EXP group also had more gains than CON subjects for the dual-task TUG time, FR distance, FTSTS time and OLS time immediately after treatment completion and at both 6-month and 12-month follow-ups. The positive findings of this study provide solid evidence that this multi-system blended indoor-outdoor balance training programme can enhance balance, dual-task gait and functional performance up to 12-month follow-up in PD non-fallers and single fallers. This BIO balance training programme also led to reductions in injurious fall risk at 6-month and 12-month follow-ups.

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