Mobility in atypical parkinsonism: a randomized trial of physiotherapy

非典型帕金森病的活动能力：物理治疗的随机试验

• 批准号: 438496663
• 负责人: Professor Dr. Bjoern Eskofier
• 金额: --
• 依托单位: Molekular-Neurologische Abteilung
• 依托单位国家: 德国
• 项目类别: Research Grants
• 资助国家: 德国
• 项目状态: 未结题
• 来源: https://gepris.dfg.de/gepris/projekt/438496663?language=en
• 关键词: Mobility; atypical; parkinsonism; randomized; trial

Mobility in atypical parkinsonism: effects of physiotherapyWider research context/theoretical frameworkParkinsonian gait disorders and reduced mobility are pivotal symptoms of Parkinson´s disease (PD) and of atypical parkinsonian disorders (APD), including Multiple System Atrophy (MSA) and Progressive Supranuclear Palsy (PSP). Their onset signs the transition towards disability and increased mortality. While several randomized controlled trials investigated efficacy of exercise-based interventions for PD, for APD this area remains thus far widely unexplored. Results of our pilot study investigating efficacy of a physiotherapy program in APD showed improvements of gait parameters as reflected by instrumented gait analysis in lab. Current advances in development of wearable sensor-based technologies now reach clinical applicability also under remote unsupervised conditions (home-monitoring).Hypotheses/research questions /objectivesIn this randomized controlled trial we expect to detect greater improvement of gait performance and mobility in PD and APD patients by gait-focused versus standard physiotherapy and home-training. In particular, we aim to investigate whether:1) Gait-focused versus standard physiotherapy and home-based exercise improve lab and home-based gait parameters, physical activity and clinical rating scales in PD and APD patients.2) PD, MSA and PSP patients differ in their response to gait-focused versus standard physiotherapy and home-based exercise as detected by lab and home-based gait parameters, physical activity and clinical rating scales.Approach/methodsThe trial will be multicentric, randomized, double-blinded and controlled. The intervention to test consists of an inpatient gait-focused physiotherapy followed by an unsupervised gait-focused home-based training program. The control group receives a standard physiotherapy/home-based training, which addresses parkinsonian features without focusing on gait. Lab gait analysis is performed by shoe-insole-sensors to retrieve objective gait parameters (e.g. gait velocity, stride length etc.). Home-monitoring is performed using similar shoe-sensors and one sensor at low-back position allowing for the analysis of routine activities such as sitting, lying, standing and walking.Level of originality/innovationImproving gait disorders in PD and APD patients by gait focused PT and home-based exercise increases patients´ independence and forestalls the risk of falls representing a great achievement for patients. This study lays the foundation for the development of a telemedical approach by which patient groups can be included in clinical trials remote from expert centers.Primary researchers involvedGregor Wenning (lead-PI), Cecilia Raccagni (study coordinator), Jochen Klucken (Erlangen-PI), David Benninger (Lausanne-PI) and Bas Bloem (Nijmegen-PI).Björn Eskofier (Erlangen) and Kamiar Aminian (Lausanne) will be responsible for the technical part concerning the sensor system.

非典型帕金森病的移动性：物理治疗的影响更广泛的研究背景/理论框架帕金森步态障碍和活动能力降低是帕金森病（PD）和非典型帕金森病（APD）的关键症状，包括多系统萎缩（MSA）和进行性核上性麻痹（PSP）。这些疾病的发生标志着向残疾和死亡率上升的过渡。虽然有几项随机对照试验研究了运动干预对PD的疗效，但对于APD，这一领域迄今为止尚未广泛探索。我们的初步研究调查了APD物理治疗计划的有效性，结果显示实验室仪器步态分析反映了步态参数的改善。目前的进展，可穿戴传感器为基础的技术的发展，现在达到临床适用性，也在远程无人监督的条件下（家庭monitoring）。假设/研究问题/objectivesIn这个随机对照试验中，我们希望检测到更大的改善步态性能和流动性PD和APD患者的步态为重点的标准物理治疗和家庭训练。特别是，我们的目的是调查是否：1）步态为重点与标准的物理治疗和家庭为基础的运动改善实验室和家庭为基础的步态参数，身体活动和临床评级量表在PD和APD patient.2）PD，MSA和PSP患者不同的反应步态为重点与标准的物理治疗和家庭为基础的运动检测实验室和家庭为基础的步态参数，身体活动和临床评级scales.Approach/methodsThe试验将是多中心，随机，双盲和对照。测试的干预措施包括一个住院的步态为重点的物理治疗，其次是一个无人监督的步态为重点的家庭为基础的训练计划。对照组接受标准的物理治疗/家庭训练，这些训练针对帕金森病的特征，而不关注步态。实验室步态分析是由鞋内底传感器进行检索的目标步态参数（如步态速度，步长等）。家庭监测使用类似的鞋传感器和一个传感器在低位进行，允许分析日常活动，如坐，躺，站立和行走。独创性/创新水平通过步态集中PT和家庭锻炼改善PD和APD患者的步态障碍，提高患者的独立性，并预防福尔斯的风险，这对患者来说是一个巨大的成就。这项研究为远程医疗方法的发展奠定了基础，通过这种方法，患者群体可以被纳入远离专家中心的临床试验。（研究协调员），Jochen Klucken（Erlangen-PI），大卫·贝宁格Björn Eskofier（埃尔兰根）和Kamiar Aminian（洛桑）将负责传感器系统的技术部分。