Highly challenging balance program to reduce fall rate in PD

项目背景/理由。帕金森病（PD）是第二常见的神经退行性疾病， 疾病，影响超过一百万美国人。PD的主要临床表现包括静止性震颤， 僵硬、运动迟缓和姿势不稳定/步态障碍（Olanow等，2009年）的报告。此外， PD经常下降，60%每年下降，其中三分之二复发（Latt等人，2009;艾伦等人 例如，2013; Bloem等人，2001年）。确定成功改善姿势控制并减少 跌倒率对于减少残疾、改善生活质量和潜在增加患者生存率至关重要。 警局最近的随机对照试验（RCT）研究了运动和物理治疗的效果 减少PD患者福尔斯跌倒的干预措施;然而，结果喜忧参半。 项目目标。减少PD患者福尔斯跌倒的有效治疗选择有限。在这 背景、来自两项荟萃分析的证据（Sherrington等人，2017;艾伦等人，2011年，他表示， 具有挑战性的锻炼方法可能会带来更好的结果。我们建议调查两种 理论驱动的，渐进的，具有高度挑战性的锻炼计划：1）以设施为基础的亲自锻炼 一个程序，证明了下降率随时间的推移在一个小样本的患者显着下降（麻雀等 例如，2016年）和2）一个新的家庭为基础的计划围绕远程，实时运动指导和 通过定期视频会议进行监督。这两个项目都将由理疗师提供， 治疗PD患者的经验。还将有一个对照组，在其中提供健康教育。 项目方法。我们建议进行一项随机对照试验，评估对跌倒率、动态平衡和恐惧的影响。 下降共有162例轻度至中度PD的VA患者将被随机分配至3个3- 月干预：在VA的人的运动，远程交付的运动，或健康教育。成果 将在每个干预组和对照组之间进行比较。主要结果将是 率将使用负二项回归模型比较两组之间的跌倒率。

Project Background/Rationale. Parkinson’s disease (PD) is the second most common neurodegenerative disease, affecting over one million Americans. The cardinal clinical manifestations of PD include resting tremor, rigidity, bradykinesia, and postural instability/gait disturbance (Olanow et al., 2009). In addition, people with PD fall frequently, with 60% falling annually and two-thirds of these falling recurrently (Latt et al., 2009; Allen et al., 2013; Bloem et al., 2001). Identifying interventions that successfully improve postural control and reduce fall rate is critical to reduce disability, improve quality of life, and potentially increase survival in patients with PD. Recent randomized, controlled trials (RCT) have examined the effects of exercise and physical therapy interventions on reducing falls in patients with PD; however, with mixed results. Project Objectives. There is a limited availability of effective treatment options to reduce falls in PD. In this context, evidence from two meta-analyses (Sherrington et al., 2017; Allen et al., 2011) indicates that highly challenging exercise approaches may lead to better outcomes. We propose investigating the effects of two theoretically driven, progressive, highly challenging exercise programs: 1) a facility-based in-person exercise program that demonstrated a significant decline in fall rate over time in a small sample of patients (Sparrow et al., 2016) and 2) a novel home-based program centered around remote, real-time exercise instruction and supervision via regular videoconferencing. Both programs will be delivered by a physical therapist with experience treating patients with PD. There will also be a control group in which health education is provided. Project Methods. We propose to conduct an RCT evaluating effects on fall rate, dynamic balance, and fear of falling. A total of 162 VA patients with mild-to-moderate PD will be randomly assigned to one of the three 3- month interventions: in-person exercise at the VA, remotely-delivered exercise, or health education. Outcomes will be compared between each intervention group and the control group. The primary outcome will be the fall rate. Fall rates will be compared between groups with the use of negative binomial regression models.