家庭中的提示训练可改善帕金森病患者与步态相关的活动能力：RESCUE试验
Cueing training in the home improves gait-related mobility in Parkinson's disease: the RESCUE trial.
作者信息
Nieuwboer A, Kwakkel G, Rochester L, Jones D, van Wegen E, Willems A M, Chavret F, Hetherington V, Baker K, Lim I
机构信息
Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit, Leuven, Belgium.
出版信息
J Neurol Neurosurg Psychiatry. 2007 Feb;78(2):134-40. doi: 10.1136/jnnp.200X.097923.
OBJECTIVES
Gait and mobility problems are difficult to treat in people with Parkinson's disease. The Rehabilitation in Parkinson's Disease: Strategies for Cueing (RESCUE) trial investigated the effects of a home physiotherapy programme based on rhythmical cueing on gait and gait-related activity.
METHODS
A single-blind randomised crossover trial was set up, including 153 patients with Parkinson's disease aged between 41 and 80 years and in Hoehn and Yahr stage II-IV. Subjects allocated to early intervention (n = 76) received a 3-week home cueing programme using a prototype cueing device, followed by 3 weeks without training. Patients allocated to late intervention (n = 77) underwent the same intervention and control period in reverse order. After the initial 6 weeks, both groups had a 6-week follow-up without training. Posture and gait scores (PG scores) measured at 3, 6 and 12 weeks by blinded testers were the primary outcome measure. Secondary outcomes included specific measures on gait, freezing and balance, functional activities, quality of life and carer strain.
RESULTS
Small but significant improvements were found after intervention of 4.2% on the PG scores (p = 0.005). Severity of freezing was reduced by 5.5% in freezers only (p = 0.007). Gait speed (p = 0.005), step length (p<0.001) and timed balance tests (p = 0.003) improved in the full cohort. Other than a greater confidence to carry out functional activities (Falls Efficacy Scale, p = 0.04), no carry-over effects were observed in functional and quality of life domains. Effects of intervention had reduced considerably at 6-week follow-up.
CONCLUSIONS
Cueing training in the home has specific effects on gait, freezing and balance. The decline in effectiveness of intervention effects underscores the need for permanent cueing devices and follow-up treatment. Cueing training may be a useful therapeutic adjunct to the overall management of gait disturbance in Parkinson's disease.
目的
帕金森病患者的步态和运动问题难以治疗。帕金森病康复：提示策略（RESCUE）试验研究了基于节奏提示的家庭物理治疗方案对步态及与步态相关活动的影响。
方法
开展了一项单盲随机交叉试验，纳入153例年龄在41至80岁、处于Hoehn和Yahr II - IV期的帕金森病患者。分配至早期干预组（n = 76）的受试者使用原型提示设备接受为期3周的家庭提示方案，随后3周不进行训练。分配至晚期干预组（n = 77）的患者按相反顺序接受相同的干预和对照期。在最初的6周后，两组均有为期6周的无训练随访。由盲法测试者在3周、6周和12周测量的姿势和步态评分（PG评分）是主要结局指标。次要结局包括关于步态、冻结和平衡、功能活动、生活质量及照料者负担的具体测量指标。
结果
干预后PG评分有小幅但显著的改善，提高了4.2%（p = 0.005）。仅在存在冻结现象的患者中，冻结严重程度降低了5.5%（p = 0.007）。整个队列的步态速度（p = 0.005）、步长（p<0.001）和定时平衡测试（p = 0.003）均有所改善。除了进行功能活动时更有信心（跌倒效能量表，p = 0.04）外，在功能和生活质量领域未观察到延续效应。在6周随访时，干预效果已大幅下降。
结论
家庭提示训练对步态、冻结和平衡有特定影响。干预效果的下降凸显了对永久性提示设备和后续治疗的需求。提示训练可能是帕金森病步态障碍整体管理中一种有用的治疗辅助手段。
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