Multimodal Balance Training Supported by Rhythmical Auditory Stimuli in Parkinson's Disease: A Randomized Clinical Trial
Multimodal Balance Training Supported by Rhythmical Auditory Stimuli in Parkinson's Disease: A Randomized Clinical Trial
复制标题
DOI：
10.3233/jpd-191752
复制
发表时间：
2020-01-01
影响因子：
5.2
通讯作者：
Bloem, Bastiaan R.
中科院分区：
文献类型：
--
作者：
Capato, Tamine T. C.;de Vries, Nienke M.;Bloem, Bastiaan R.
背景：多巴胺能药物仅能部分改善帕金森病（PD）的平衡障碍。因此，非药物干预如物理治疗是临床管理的重要组成部分。外部提示常用于改善步态，但其对平衡控制的影响尚不清楚。目的/方法：我们进行了一项前瞻性、单盲、随机临床试验，研究有节奏听觉提示和没有节奏听觉提示的平衡训练的有效性。我们通过电话筛选了201名志愿者；154名受试者随机分为三组：(1)有节奏听觉刺激支持的多模态平衡训练（n = 56） （ras支持的多模态平衡训练）；(2)无节奏性听觉刺激的定期多模态平衡训练（n = 50）；(3)涉及通识教育计划的对照干预（n = 48）。训练为期5周，每周2次。所有结果均采用线性混合模型。主要指标为训练结束后的最小最佳（MBEST）评分。评估由一名单盲评估者在基线、干预后立即、1个月和6个月随访后进行。结果干预后立即，ras支持的多模态平衡训练在MBEST上比常规多模态平衡训练更有效(差异3.5(95%置信区间（CI） 2.2；4.8)), p < 0.001)。与对照组相比，分配到两种积极干预措施的患者均得到改善(MBEST估计平均差值与对照组相比为6.6 (CI 5.2; 8.0)， ras支持的多模式平衡训练p < 0.001；3.0 (CI 2.7; 5.3)，常规多模式平衡训练p < 0.001)。在一个月的随访中，两种积极干预都保持了改善，但只有ras支持的多模式平衡训练组在6个月时保持了改善。结论：ras支持的多模态平衡训练和常规多模态平衡训练都能改善平衡，但ras支持的多模态平衡训练——在常规多模态平衡训练的基础上加入有节奏的听觉线索——效果更大、更持久。
Background: Balance impairment in Parkinson's disease (PD) improves only partially with dopaminergic medication. Therefore, non-pharmacological interventions such as physiotherapy are important elements in clinical management. External cues are often applied to improve gait, but their effects on balance control are unclear.Objective/Methods: We performed a prospective, single-blind, randomized clinical trial to study the effectiveness of balance training with and without rhythmical auditory cues. We screened 201 volunteers by telephone; 154 were assigned randomly into three groups: (1) multimodal balance training supported by rhythmical auditory stimuli (n = 56) (RAS-supported multimodal balance training); (2) regular multimodal balance training without rhythmical auditory stimuli (n = 50); and (3) control intervention involving a general education program (n = 48). Training was performed for 5 weeks, two times/week. Linear mixed models were used for all outcomes. Primary outcome was the Mini-BESTest (MBEST) score immediately after the training period. Assessments were performed by a single, blinded assessor at baseline, immediately post intervention, and after one and 6-months follow-up.Results Immediately post intervention, RAS-supported multimodal balance training was more effective than regular multimodal balance training on MBEST (difference 3.5 (95% Confidence Interval (CI) 2.2; 4.8)), p < 0.001). Patients allocated to both active interventions improved compared to controls (MBEST estimated mean difference versus controls 6.6 (CI 5.2; 8.0), p < 0.001 for RAS-supported multimodal balance training; and 3.0 (CI 2.7; 5.3), p < 0.001 for regular multimodal balance training). Improvements were retained at one-month follow-up for both active interventions, but only the RAS-supported multimodal balance training group maintained its improvement at 6 months.Conclusion: Both RAS-supported multimodal balance training and regular multimodal balance training improve balance, but RAS-supported multimodal balance training- adding rhythmical auditory cues to regular multimodal balance training- has greater and more sustained effects.