Lim I, van Wegen E, de Goede C, Deutekom M, Nieuwboer A, Willems A, Jones D, Rochester L, Kwakkel G
Department of Physiotherapy, VU University Medical Center, De Boelelaan 1117, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
Clin Rehabil. 2005 Oct;19(7):695-713. doi: 10.1191/0269215505cr906oa.
To critically review studies evaluating the effects of external rhythmical cueing on gait in patients with Parkinson's disease.
Articles published from 1966 to January 2005 were searched by two physiotherapists in MEDLINE, PiCarta, PEDRo, Cochrane, DocOnline, CINAHL and SUMSEARCH. To be included, articles had to investigate the effects of external rhythmical cueing (i.e., auditory, visual or tactile cueing) on gait parameters in patients with idiopathic Parkinson's disease. Both controlled and noncontrolled studies were included. Based on the type of design and methodological quality a meta-analysis or best-evidence synthesis was applied.
Twenty-four studies (total number of patients = 626) out of the 159 screened studies were evaluated in this systematic review. Two out of 24 were randomized controlled trails (RCT), both of high methodological quality. One RCT did not focus specifically on external rhythmical cueing of individual patients with Parkinson's disease, but on group exercises in general, including walking with cues. All other studies were pre-experimental studies. Best-evidence synthesis showed strong evidence for improving walking speed with the help of auditory cues. Insufficient evidence was found for the effectiveness of visual and somatosensory cueing.
Only one high-quality study, specifically focused on the effects of auditory rhythmical cueing, suggesting that the walking speed of patients with Parkinson's disease can be positively influenced. However, it is unclear whether positive effects identified in the laboratory can be generalized to improved activities of daily living (ADLs) and reduced frequency of falls in the community. In addition, the sustainability of a cueing training programme remains uncertain.
批判性地综述评估外部节奏提示对帕金森病患者步态影响的研究。
两名物理治疗师在MEDLINE、PiCarta、PEDRo、Cochrane、DocOnline、CINAHL和SUMSEARCH中检索了1966年至2005年1月发表的文章。纳入的文章必须研究外部节奏提示（即听觉、视觉或触觉提示）对特发性帕金森病患者步态参数的影响。纳入了对照研究和非对照研究。根据设计类型和方法学质量进行荟萃分析或最佳证据综合分析。
在本次系统评价中，对159项筛选研究中的24项研究（患者总数=626）进行了评估。24项研究中有2项是随机对照试验（RCT），两者的方法学质量都很高。一项RCT没有专门关注帕金森病个体患者的外部节奏提示，而是关注一般的团体运动，包括有提示的行走。所有其他研究都是实验前研究。最佳证据综合分析表明，有强有力的证据支持在听觉提示的帮助下提高步行速度。未发现视觉和体感提示有效性的充分证据。
只有一项高质量研究专门关注听觉节奏提示的影响，表明帕金森病患者的步行速度可受到积极影响。然而，尚不清楚在实验室中确定的积极效果是否能推广到改善日常生活活动（ADL）和降低社区跌倒频率。此外，提示训练计划的可持续性仍不确定。
