Lohkamp Monika, Braun Cordula, Wasner Mieke, Voigt-Radloff Sebastian
Fakultät für Therapiewissenschaften, SRH Hochschule Heidelberg, Heidelberg, Deutschland.
hochschule 21, Buxtehude, Deutschland.
Z Evid Fortbild Qual Gesundhwes. 2014;108 Suppl 1:S29-35. doi: 10.1016/j.zefq.2014.09.005. Epub 2014 Oct 8.
Parkinson's disease is one of the major neurodegenerative disorders with prevalence rates between 0.1 and 0.2 % in the global population and 1.8 % in people aged 64 years and over. Future incidence rates are estimated to increase within aging societies. The progressive course of Parkinson's disease is clinically characterised by bradykinesia, rigidity and tremor. These limitations in motor functioning reduce the capacity to work, social participation and the clients' quality of life. Parkinson's disease causes incapacity to work and a large number of days off from work. The benefits clients expect from physiotherapy-led treatment include an improvement of gait, a better speed of motion and the decrease of fatigue and rigidity.
A recent Cochrane review (Mehrholz et al., 2010) analysed seven randomised comparisons with 153 participants and found that treadmill training compared with no treatment improved gait speed (SMD 0.50; 95 % confidence interval [0.17 to 0.84]). A lack of evidence exists on how to reduce fatigue and rigidity. There is also need to evaluate long-term effects and cost-effectiveness. Furthermore, an updated meta-analysis should include eleven new randomised trials on treadmill training after 2009. Physiotherapy-led treadmill training can easily be transferred into the German healthcare context since the environmental and educational preconditions are met by German physiotherapeutic care.
Within the German context, there is need to prepare a randomised clinical trial evaluating the impact of physiotherapy-led treadmill training on motor functioning, quality of life, costs, adverse events und long-term effects. Prior to this, a feasibility study should explore the acceptance and intensity of treadmill training as well as the access of private physiotherapy practices to people suffering from early- to mid-stage Parkinson's disease.
帕金森病是主要的神经退行性疾病之一，全球患病率在0.1%至0.2%之间，64岁及以上人群中患病率为1.8%。预计在老龄化社会中，未来发病率还会上升。帕金森病的进展过程在临床上表现为运动迟缓、僵硬和震颤。这些运动功能限制降低了工作能力、社会参与度以及患者的生活质量。帕金森病导致无法工作和大量旷工。患者期望物理治疗主导的治疗能带来的益处包括改善步态、提高运动速度以及减轻疲劳和僵硬程度。
最近一项Cochrane综述（Mehrholz等人，2010年）分析了7项随机对照研究，涉及153名参与者，发现与不治疗相比，跑步机训练可提高步态速度（标准化均数差0.50；95%置信区间[0.17至0.84]）。关于如何减轻疲劳和僵硬程度，目前缺乏证据。还需要评估长期效果和成本效益。此外，一项更新的荟萃分析应纳入2009年后关于跑步机训练的11项新的随机试验。由于德国物理治疗护理满足环境和教育前提条件，物理治疗主导的跑步机训练可以很容易地应用于德国医疗保健环境。
在德国背景下，有必要开展一项随机临床试验，评估物理治疗主导的跑步机训练对运动功能、生活质量、成本、不良事件和长期效果的影响。在此之前，一项可行性研究应探索跑步机训练的可接受性和强度，以及私人物理治疗诊所接纳早中期帕金森病患者的情况。
