A Randomized Controlled Feasibility Trial of a Specific Cueing Program for Falls Management in Persons With Parkinson Disease and Freezing of Gait.

Abstract

Freezing of gait (FOG) increases fall risk in persons with Parkinson disease (PD). Cueing improves gait parameters associated with freezing, but it is unclear whether a cueing program can address falling. We used a parallel-groups delayed- (n = 12) or immediate-start (n = 9) randomized controlled trial design to evaluate a cueing exercise program for FOG and falls in participants with PD. Each group received preintervention falls monitoring, followed by a 6-month standardized, home-based, cueing exercise and education program. Participant questionnaires rated program value and compliance. Freezing was measured with the New Freezing of Gait Questionnaire (NFOGQ). Falls were recorded by weekly diaries. Self-reported adherence was high; 83% of participants reported exercising after 6 months. Participants reported that the program was beneficial (89%), walking improved (78%), falls were fewer (73%), and self-management of freezing improved (61%). Mean (standard deviation) NFOGQ scores were 14.8 (5.0), for the immediate (n = 10), and 16.0 (7.7) for the delayed group (n = 9), after 6 months (difference -1.0 [95% confidence interval, -7.9 to 6.0; P = 0.78]). With baseline NFOGQ scores as a covariate, the estimate of difference was -0.7 (95% confidence interval, -6.1 to 4.7; P = 0.79). The relative rate of falls for immediate compared with delayed groups was 1.22 (95% confidence interval, 0.45 to 3.26). The cueing program intervention is acceptable and participants feel they improve; however, this small feasibility study lacks statistical power to detect important changes in falls rates or FOG severity. A larger study is warranted to further investigate the potential to influence FOG and falls.Video Abstract available for more insights from the authors (Supplemental Digital Content 1, http://links.lww.com/JNPT/A105).