Highly challenging balance program to reduce fall rate in PD

极具挑战性的平衡计划，可降低 PD 跌倒率

• 批准号: 10201779
• 负责人: DAVID W. SPARROW
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10201779
• 关键词: Affect; American; Bradykinesia; Caring; Clinical; Control Groups; Equilibrium; Exercise; Exercise Therapy; Gait abnormality; Goals; Health; Health education; Healthcare Systems; Home; Instruction; International; Intervention; Lead; Medical center; Meta-Analysis; Methodology; Methods; Modeling; Musculoskeletal Equilibrium; Neurodegenerative Disorders; Outcome; Parkinson Disease; Patients; Persons; Physical therapy; Population; Quality of life; Randomized; Randomized Controlled Trials; Recurrence; Research; Rest Tremor; Sampling; Sparrows; Supervision; Technology; Testing; Therapeutic Intervention; Time; Veterans; Videoconferencing; base; disability; effective therapy; exercise intervention; exercise program; experience; fall risk; falls; fear of falling; group intervention; improved; novel; physical therapist; posture instability; primary outcome; programs; remote delivery

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.

项目背景/基本原理。帕金森病(PD)是第二常见的神经退行性疾病 疾病，影响了100多万美国人。帕金森病的主要临床表现为静止性震颤， 僵硬、运动迟缓和姿势不稳/步态障碍(Olanow等人，2009年)。此外，患有疾病的人 PD经常下降，其中60%每年下降，其中三分之二反复下降(Latt等人，2009；Allen等人 等人，2013年；Bloem等人，2001年)。确定成功改善姿势控制和减少 坠落率对减少残疾、改善生活质量以及潜在地增加患者的存活率至关重要 警察。最近的随机对照试验(RCT)检验了锻炼和理疗的效果。 减少帕金森病患者跌倒的干预措施；然而，结果喜忧参半。 项目目标。减少帕金森病跌倒的有效治疗选择有限。在这 背景，来自两个元分析(Sherrington等人，2017；Allen等人，2011)的证据表明 具有挑战性的锻炼方法可能会带来更好的结果。我们建议调查两个因素的影响 理论驱动的、进步的、极具挑战性的锻炼计划：1)基于设施的面对面锻炼 在一小部分患者中，随着时间的推移，跌倒发生率显著下降的计划(Sparrow et Al，2016)和2)以远程、实时运动指导和 通过定期视频会议进行监督。这两个项目都将由一名物理治疗师提供 治疗帕金森病患者的经验。还将设立一个对照组，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，评估跌倒几率、动态平衡和恐惧心理的影响。 坠落。总共162名患有轻中度帕金森病的VA患者将被随机分配到三个3- 月干预：退伍军人管理局的面对面锻炼、远程锻炼或健康教育。结果 将各干预组与对照组进行比较。主要结果将是坠落 费率。跌倒比率将使用负二项回归模型在不同组之间进行比较。