Abstract
Background: Gait impairments are common in healthy older adults (HOA) and people with Parkinson's disease (PwPD), especially when adaptations to the environment are required. Traditional rehabilitation programs do not typically address these adaptive gait demands in contrast to repeated gait perturbation training (RGPT). RGPT is a novel reactive form of gait training with potential for both short and long-term consolidation in HOA and PwPD. The aim of this systematic review with meta-analysis is to determine whether RGPT is more effective than non-RGPT gait training in improving gait and balance in HOA and PwPD in the short and longer term.Methods: This review was conducted according to the PRISMA-guidelines and pre-registered in the PROSPERO database (CRD42020183273). Included studies tested the effects of any form of repeated perturbations during gait in HOA and PwPD on gait speed, step or stride length. Studies using balance scales or sway measures as outcomes were included in a secondary analysis. Effects of randomized controlled trials (RCT) on RGPT were pooled using a meta-analysis of final measures.Results: Of the 4421 studies, eight studies were deemed eligible for review, of which six could be included in the meta-analysis, totaling 209 participants (159 PwPD and 50 HOA). The studies were all of moderate quality. The meta-analysis revealed no significant effects of RGPT over non-RGPT training on gait performance (SMD = 0.16; 95% CI = −0.18, 0.49; Z = 0.92; P = 0.36). Yet, in some individual studies, favorable effects on gait speed, step length and stride length were observed immediately after the intervention as well as after a retention period. Gait variability and asymmetry, signifying more direct outcomes of gait adaptation, also indicated favorable RGPT effects in some individual studies.Conclusion: Despite some promising results, the pooled effects of RGPT on gait and balance were not significantly greater as compared to non-RGPT gait training in PwPD and HOA. However, these findings could have been driven by low statistical power. Therefore, the present review points to the imperative to conduct sufficiently powered RCT's to verify the true effects of RGPT on gait and balance in HOA and PwPD.Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php? Identifier: CRD42020183273.
Highlights
Gait impairments in the aging population are related to falls and have other serious repercussions, such as that they are associated with reduced physical activity levels (Campbell et al, 1989; Seematter-Bagnoud et al, 2006)
Cakit et al (2007) found a significant improvement of 0.20 m/s in maximum tolerated walking speed on the treadmill in people with Parkinson’s disease (PwPD) compared to the control group, immediately after a
Shen and Mak (2015) did not find an improvement in over-ground gait speed, but did find a significant increase in stride length in PwPD immediately (ES = 0.968, p = 0.003), 6 months (ES = 0.643, p = 0.038) and 12 months (ES = 0.783, p = 0.013) after their technology-assisted balance and gait training including sudden decelerations during treadmill walking (Shen and Mak, 2015). They reported a significantly lower number of fallers after repeated gait perturbation training (RGPT) compared to the control intervention, which was retained for 12 months (p = 0.047) (Shen and Mak, 2015)
Summary
Gait impairments in the aging population are related to falls and have other serious repercussions, such as that they are associated with reduced physical activity levels (Campbell et al, 1989; Seematter-Bagnoud et al, 2006). Gait impairments and their negative consequences are further exacerbated in people with Parkinson’s disease (PwPD) (Bouça-Machado et al, 2020). Gait impairments are common in healthy older adults (HOA) and people with Parkinson’s disease (PwPD), especially when adaptations to the environment are required. The aim of this systematic review with meta-analysis is to determine whether RGPT is more effective than non-RGPT gait training in improving gait and balance in HOA and PwPD in the short and longer term
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