Abstract
In order for people with Parkinson disease (PwPD) to benefit from neurorehabilitation research, interventions tested in research settings require assessment in real-world clinical practice. There is little evidence for whether efficacious exercise interventions for PwPD remain effective when transferred to standard clinical settings. The aim of this study was to assess the clinical effectiveness of the adapted HiBalance program on balance control and gait among PwPD. Participants (n = 117) with mild-moderate Parkinson disease were consecutively included into either the 10-week HiBalance group training (n = 61) or the control (n = 56) group. The main outcome was balance performance (Mini-BESTest). Secondary outcomes were comfortable gait speed (10-m Walk Test); functional mobility (Timed Up and Go [TUG] test) and dual-task interference (cognitive TUG test); physical activity level (steps per day); perceived balance confidence (Activities-specific Balance Confidence scale) and perceived walking difficulty (Walk-12G) and self-rated health (EQ-5D visual analog scale). In total, 98 people completed the trial. Compared with controls, the training group showed significant improvement in balance performance (P < 0.001), gait speed (P = 0.001), and dual-task interference (P = 0.04) following the intervention. No group differences were observed for physical activity level or any patient-reported measures. Highly challenging balance training is effective at improving balance, gait, and dual-task performance when delivered at a clinically feasible dose, in a range of rehabilitation settings, without direct involvement of the research group.Video Abstract available for more insights from the authors (see the Video, Supplementary Digital Content 1, available at: http://links.lww.com/JNPT/A299).
Highlights
Parkinson disease (PD) is a highly disabling condition, involving motor and nonmotor symptoms, which culminate in balance and gait impairments and reduced quality of life
It is important that people with PD (PwPD) can avail of specialized rehabilitation, which is in line with current best evidence
This study investigated whether highly challenging balance training is clinically effective when delivered to PwPD, in a variety of clinical settings as a part of standard rehabilitative practice
Summary
Parkinson disease (PD) is a highly disabling condition, involving motor and nonmotor symptoms, which culminate in balance and gait impairments and reduced quality of life. Evidence for the efficacy of exercise interventions on balance control and gait in PD is compelling.[1,2,3] Systematic reviews report that facility-based balance training in particular provides the longest carryover effects.[1,4] studies investigating explanatory mechanisms for improved motor symptoms report positive trends in exercise-induced brain plasticity.[5,6] For PwPD to benefit from neurorehabilitation research, the findings from randomized controlled settings require assessment in real-world clinical practice among typical patients and resources. There is little evidence for whether the effects of efficacious exercise interventions for PwPD are maintained when transferred to clinical practice. In order for people with Parkinson disease (PwPD) to benefit from neurorehabilitation research, interventions tested in research settings require assessment in real-world clinical practice. Secondary outcomes were comfortable gait speed (10-m Walk Test); functional mobility (Timed Up and Go [TUG] test) and dual-task interference (cognitive TUG test); physical activity level (steps per day); perceived balance confidence (Activities-specific Balance Confidence scale) and perceived walking difficulty (Walk-12G) and self-rated health (EQ-5D visual analog scale)
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