Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, The Netherlands.
Parkinsonism Relat Disord. 2018 Oct;55:86-91. doi: 10.1016/j.parkreldis.2018.05.018. Epub 2018 May 18.
The DUALITY trial recently showed that both integrated and consecutive dual-task training improve dual-task gait velocity, without increasing fall risks in patients with Parkinson's disease (PD). Gait velocity was the primary outcome; not reported, however, were important gait measures related to the risk of falling such as gait variability. In this secondary analysis, we compared the efficacy of the two training programs with respect to spatiotemporal outcome parameters.
121 PD patients (Hoehn and Yahr stage II-III while ON medication) were randomly assigned to either a consecutive group (n = 65) in which cognitive and gait tasks were trained separately, or an integrated group (n = 56) in which cognitive and gait tasks were trained simultaneously. Both groups received 24 in-home physiotherapy sessions for six consecutive weeks. Two baseline measurements were performed during a six-week control period prior to the interventions. Gait was evaluated under three different (and untrained) dual-task conditions immediately after the treatment period and at 12-week follow-up.
Both training modalities had a comparable effect on spatiotemporal gait parameters. A significant post-training increase in stride length (P < .001) and cadence (P < .001) was found under both the single and the dual-task conditions. These improvements were maintained at follow-up, although the effect was slightly reduced. No significant changes were found for gait variability under single and dual-task conditions.
We found both integrated and consecutive dual-task training to be safe and effective in improving several spatiotemporal gait parameters under trained and untrained dual-task conditions.
最近的 DUALITY 试验表明，综合和连续双重任务训练均可改善帕金森病（PD）患者的双重任务步态速度，而不会增加跌倒风险。步态速度是主要结果；但未报告与跌倒风险相关的重要步态测量值，例如步态变异性。在这项二次分析中，我们比较了两种训练方案在时空结果参数方面的效果。
121 名 PD 患者（Hoehn 和 Yahr 分期 II-III 期，同时服用药物）被随机分配到连续组（n=65）或综合组（n=56）。连续组分别训练认知和步态任务，综合组同时训练认知和步态任务。两组均在 6 周的干预前控制期内接受 24 次家庭物理治疗。在治疗期结束后和 12 周随访时，在三种不同（未经训练）的双重任务条件下评估步态。
两种训练方式在时空步态参数上均具有可比性的效果。在单一和双重任务条件下，步幅（P<.001）和步频（P<.001）均显著增加。这些改善在随访时得以维持，尽管效果略有降低。在单一和双重任务条件下，步态变异性没有明显变化。
我们发现综合和连续双重任务训练在改善训练和未训练的双重任务条件下的多个时空步态参数方面都是安全有效的。
