Mehrholz Jan, Kugler Joachim, Storch Alexander, Pohl Marcus, Hirsch Kathleen, Elsner Bernhard
Wissenschaftliches Institut, Private Europäische Medizinische Akademie der Klinik Bavaria in Kreischa GmbH, An der Wolfsschlucht 1-2, Kreischa, Germany, 01731.
Cochrane Database Syst Rev. 2015 Sep 13;2015(9):CD007830. doi: 10.1002/14651858.CD007830.pub4.
Treadmill training is used in rehabilitation and is described as improving gait parameters of patients with Parkinson's disease.
To assess the effectiveness of treadmill training in improving the gait of patients with Parkinson's disease and the acceptability and safety of this type of therapy.
We searched the Cochrane Movement Disorders Group Specialised Register (see Review Group details for more information) (last searched September 2014), Cochrane Central Register of Controlled Trials (The Cochrane Library 2014, Issue 10), MEDLINE (1950 to September 2014), and EMBASE (1980 to September 2014). We also handsearched relevant conference proceedings, searched trials and research registers, and checked reference lists (last searched September 2014). We contacted trialists, experts and researchers in the field and manufacturers of commercial devices.
We included randomised controlled trials comparing treadmill training with no treadmill training in patients with Parkinson's disease.
Two review authors independently selected trials for inclusion, assessed trial quality and extracted data. We contacted the trialists for additional information. We analysed the results as mean differences (MDs) for continuous variables and relative risk differences (RD) for dichotomous variables.
We included 18 trials (633 participants) in this update of this review. Treadmill training improved gait speed (MD = 0.09 m/s; 95% confidence interval (CI) 0.03 to 0.14; P = 0.001; I(2) = 24%; moderate quality of evidence), stride length (MD = 0.05 metres; 95% CI 0.01 to 0.09; P = 0.01; I(2) = 0%; low quality of evidence), but walking distance (MD = 48.9 metres; 95% CI -1.32 to 99.14; P = 0.06; I(2) = 91%; very low quality of evidence) and cadence did not improve (MD = 2.16 steps/minute; 95% CI -0.13 to 4.46; P = 0.07; I(2) = 28%; low quality of evidence) at the end of study. Treadmill training did not increase the risk of patients dropping out from intervention (RD = -0.02; 95% CI -0.06 to 0.02; P = 0.32; I(2) = 13%; moderate quality of evidence). Adverse events were not reported in included studies.
AUTHORS' CONCLUSIONS: This update of our systematic review provides evidence from eighteen trials with moderate to low risk of bias that the use of treadmill training in patients with PD may improve clinically relevant gait parameters such as gait speed and stride length (moderate and low quality of evidence, respectively). This apparent benefit for patients is, however, not supported by all secondary variables (e.g. cadence and walking distance). Comparing physiotherapy and treadmill training against other alternatives in the treatment of gait hypokinesia such as physiotherapy without treadmill training this type of therapy seems to be more beneficial in practice without increased risk. The gain seems small to moderate clinically relevant. However, the results must be interpreted with caution because it is not known how long these improvements may last and some studies used no intervention in the control group and underlie some risk of bias. Additionally the results were heterogenous and we found variations between the trials in patient characteristics, the duration and amount of training, and types of treadmill training applied.
跑步机训练用于康复治疗，据说可改善帕金森病患者的步态参数。
评估跑步机训练对改善帕金森病患者步态的有效性以及这种治疗方法的可接受性和安全性。
我们检索了Cochrane运动障碍组专业注册库（更多信息见综述组详情）（最后检索时间为2014年9月）、Cochrane对照试验中心注册库（《Cochrane图书馆》2014年第10期）、MEDLINE（1950年至2014年9月）和EMBASE（1980年至2014年9月）。我们还手工检索了相关会议论文集，检索了试验和研究注册库，并检查了参考文献列表（最后检索时间为2014年9月）。我们联系了该领域的试验者、专家、研究人员以及商用设备制造商。
我们纳入了比较帕金森病患者跑步机训练与无跑步机训练的随机对照试验。
两位综述作者独立选择纳入试验，评估试验质量并提取数据。我们联系试验者获取更多信息。我们将连续变量的结果分析为均值差（MDs），将二分变量的结果分析为相对风险差（RD）。
在本综述的此次更新中，我们纳入了18项试验（633名参与者）。跑步机训练改善了步速（MD = 0.09米/秒；95%置信区间（CI）0.03至0.14；P = 0.001；I² = 24%；证据质量中等）、步长（MD = 0.05米；95%CI 0.01至0.09；P = 0.01；I² = 0%；证据质量低），但在研究结束时步行距离（MD = 48.9米；95%CI -1.32至99.14；P = 0.06；I² = 91%；证据质量极低）和步频未得到改善（MD = 2.16步/分钟；95%CI -0.13至4.46；P = 0.07；I² = 28%；证据质量低）。跑步机训练未增加患者退出干预的风险（RD = -0.02；95%CI -0.06至0.02；P = 0.32；I² = 13%；证据质量中等）。纳入研究中未报告不良事件。
我们系统综述的此次更新提供了来自18项试验的证据，这些试验存在中度至低度偏倚风险，表明在帕金森病患者中使用跑步机训练可能改善临床相关的步态参数，如步速和步长（分别为中等和低质量证据）。然而，并非所有次要变量（如步频和步行距离）都支持对患者的这种明显益处。与物理治疗和跑步机训练与其他治疗步态运动迟缓的替代方法（如无跑步机训练的物理治疗）相比，这种治疗方法在实际应用中似乎更有益且风险未增加。临床上相关的获益似乎较小至中等。然而，对结果的解释必须谨慎，因为尚不清楚这些改善可能持续多长时间，并且一些研究在对照组中未设置干预，存在一定的偏倚风险。此外，结果存在异质性，我们发现各试验在患者特征、训练持续时间和量以及应用的跑步机训练类型方面存在差异。
