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: 10436875
• 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/10436875
• 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/理由。帕金森病 (PD) 是第二常见的神经退行性疾病 疾病，影响了超过一百万美国人。 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）。此外，患有以下疾病的人 PD 频繁跌倒，其中 60% 每年跌倒，其中三分之二反复跌倒（Latt 等人，2009 年；Allen 等人） 等，2013；布洛姆等人，2001）。确定可成功改善姿势控制并减少 跌倒率对于减少残疾、改善生活质量并可能提高患者的生存率至关重要 PD。最近的随机对照试验 (RCT) 检查了运动和物理治疗的效果 减少帕金森病患者跌倒的干预措施；然而，结果好坏参半。 项目目标。减少帕金森病跌倒的有效治疗方案有限。在这个 在此背景下，两项荟萃分析的证据（Sherrington 等人，2017 年；Allen 等人，2011 年）表明，高度 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、渐进的、极具挑战性的锻炼计划：1) 基于设施的现场锻炼 该计划表明，一小部分患者样本的跌倒率随着时间的推移显着下降（Sparrow 等 al., 2016) 和 2) 一个新颖的家庭计划，以远程、实时锻炼指导为中心， 通过定期视频会议进行监督。这两个项目都将由物理治疗师提供 治疗PD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，评估对跌倒率、动态平衡和恐惧的影响 坠落。总共 162 名患有轻度至中度 PD 的 VA 患者将被随机分配到三个 3- 月干预措施：在 VA 亲自锻炼、远程锻炼或健康教育。结果 将在每个干预组和对照组之间进行比较。主要结果将是秋季 速度。将使用负二项式回归模型比较各组之间的跌倒率。