Abstract
Background Posture, gait and balance problems are very disabling symptoms in Parkinson’s disease (PD). Gait cycle in PD shows increased stride-to-stride variability because of the reduction of gait automaticity and asymmetry of lower limbs function. These feature predispose to freezing of gait (FOG) and recurrent falls. Aim of the study was to evaluate how the modulation of asymmetry through physiotherapy might improve gait and FOG preventing falls. Methods Twenty-eight PD patients entered the study and were evaluated at baseline and after three months of rehabilitative program (performed twice a week) by means of the motor part of the Unified Parkinson’s Disease Rating Scale (UPDRS-III), Gait and Falls Questionnaire (GFQ), Tinetti balance and gait scale, Short Physical Performance Battery (SPPB), European Quality of Life questionnaire (EQ-5D). Patients were randomly assigned to (1) physiotherapy for worst side improvement (WSI), (2) physiotherapy for best side improvement (BSI), and (3) standard physical therapy (SPT). Patients were unaware of study’s aim and evaluations were carried out by blinded physiotherapist and doctor. Results After three months, all three groups showed a significant improvement at the Tinetti and SPPB scores. The magnitude of change (end of treatment compared to baseline) was analyzed among groups: BSI led to a greater improvement than SPT in terms of UPDRS-III ( p = 0.01), Tinetti total score ( p = 0.05) and Tinetti gait subscore ( p = 0.01). No other significant differences arose. Conclusions Our study confirms the usefulness of physical therapy in the treatment of PD and, more importantly, suggests that specific intervention tailored on individual feature (e.g. asymmetry of motor condition) might be even more effective than standard rehabilitative programs. The impact of such approach on the benefit duration and rate of falls should be prospectively assessed by future trials.
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