Morris Meg E, Menz Hylton B, McGinley Jennifer L, Watts Jennifer J, Huxham Frances E, Murphy Anna T, Danoudis Mary E, Iansek Robert
La Trobe University, Bundoora, Victoria, Australia
La Trobe University, Bundoora, Victoria, Australia.
Neurorehabil Neural Repair. 2015 Sep;29(8):777-85. doi: 10.1177/1545968314565511. Epub 2015 Jan 7.
Falls are common and disabling in people with Parkinson's disease (PD). There is a need to quantify the effects of movement rehabilitation on falls in PD.
To evaluate 2 physical therapy interventions in reducing falls in PD.
We randomized 210 people with PD to 3 groups: progressive resistance strength training coupled with falls prevention education, movement strategy training combined with falls prevention education, and life-skills information (control). All received 8 weeks of out-patient therapy once per week and a structured home program. The primary end point was the falls rate, recorded prospectively over a 12 month period, starting from the completion of the intervention. Secondary outcomes were walking speed, disability, and quality of life.
A total of 1547 falls were reported for the trial. The falls rate was higher in the control group compared with the groups that received strength training or strategy training. There were 193 falls for the progressive resistance strength training group, 441 for the movement strategy group and 913 for the control group. The strength training group had 84.9% fewer falls than controls (incidence rate ratio [IRR] = 0.151, 95% CI 0.071-0.322, P < .001). The movement strategy training group had 61.5% fewer falls than controls (IRR = 0.385, 95% CI 0.184-0.808, P = .012). Disability scores improved in the intervention groups following therapy while deteriorating in the control group.
Rehabilitation combining falls prevention education with strength training or movement strategy training reduces the rate of falls in people with mild to moderately severe PD and is feasible.
帕金森病（PD）患者中跌倒很常见且会导致残疾。有必要量化运动康复对PD患者跌倒的影响。
评估两种物理治疗干预措施对减少PD患者跌倒的效果。
我们将210名PD患者随机分为3组：渐进性抗阻力量训练联合跌倒预防教育、运动策略训练联合跌倒预防教育以及生活技能信息（对照组）。所有患者均接受为期8周的每周一次门诊治疗以及一个结构化的家庭训练计划。主要终点是跌倒率，从干预结束后开始前瞻性记录12个月。次要结局包括步行速度、残疾程度和生活质量。
该试验共报告了1547次跌倒。与接受力量训练或策略训练的组相比，对照组的跌倒率更高。渐进性抗阻力量训练组有193次跌倒，运动策略组有441次跌倒，对照组有913次跌倒。力量训练组的跌倒次数比对照组少84.9%（发病率比[IRR]=0.151，95%CI 0.071 - 0.322，P <.001）。运动策略训练组的跌倒次数比对照组少61.5%（IRR = 0.385，95%CI 0.184 - 0.808，P =.012）。治疗后干预组的残疾评分改善，而对照组恶化。
将跌倒预防教育与力量训练或运动策略训练相结合的康复治疗可降低轻度至中度重度PD患者的跌倒率，且是可行的。
