Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital, Gravedona ed Uniti, Italy.
Department of Biomedical Engineering, Istituti Clinici Scientifici Maugeri Spa Società Benefit, IRCCS, Pavia, Italy.
Phys Ther. 2019 May 1;99(5):591-600. doi: 10.1093/ptj/pzz003.
Freezing of gait (FOG) is one of the most disabling symptoms of Parkinson disease (PD). Different land-based rehabilitation approaches based on motor and cognitive strategies can be effective in treating FOG. Although there are data about the efficacy of aquatic therapy in ameliorating this phenomenon, no study has explored the combined effect of land-based therapies plus aquatic therapy in patients with PD who have FOG.
The objective was to investigate the effectiveness of a multidisciplinary, intensive, motor-cognitive rehabilitation treatment (MIRT) in improving FOG and whether implementation with aquatic therapy (MIRT-AT) adds further benefits.
The design consisted of a single-blind, parallel-group, 1:1 allocation ratio, randomized trial.
The Department of Parkinson Disease, Movement Disorders and Brain Injury Rehabilitation at "Moriggia-Pelascini" Hospital (Gravedona ed Uniti, Como, Italy) was used as the setting.
Sixty hospitalized patients with PD who had FOG in Hoehn and Yahr stage 2 or 5-3 were included.
Sixty patients with PD + FOG were randomly assigned to 2 groups: 30 underwent a 4-week MIRT and 30 underwent a 4-week MIRT-AT.
The primary outcome measure was the Freezing of Gait Questionnaire; secondary outcome measures were total Unified Parkinson Disease Rating Scale (UPDRS), UPDRS II, UPDRS III, Berg Balance Scale, Timed Up and Go Test, and 6-Minute Walk Test. These measures were assessed both at admission and discharge.
Participants in the 2 groups had similar age, sex distribution, Hoehn and Yahr stage, and most-affected side. At baseline, no difference in outcome measures was observed between the 2 groups. After treatment, a significant time effect was observed for all variables in both groups. No significant time × group interaction was observed. A between-group analysis showed nonsignificant differences between values at T1 and values at T0 for all variables.
The limitations were the lack of a control group and follow-up.
We showed that a multidisciplinary, intensive, and goal-based rehabilitation treatment, such as MIRT, improves FOG in patients with PD. Although aquatic therapy could be considered a useful approach for treating FOG, it does not add further benefits to this kind of motor-cognitive rehabilitation.
冻结步态（FOG）是帕金森病（PD）最致残的症状之一。基于运动和认知策略的不同陆地康复方法可有效治疗 FOG。尽管有关于水疗改善这种现象的疗效的数据，但尚无研究探讨 PD 合并 FOG 患者联合陆地治疗加水上治疗的综合效果。
本研究旨在探讨多学科、强化、运动认知康复治疗（MIRT）改善 FOG 的效果，以及是否结合水上治疗（MIRT-AT）会带来更多获益。
本研究采用单盲、平行分组、1:1 分配比例、随机试验设计。
意大利科莫省格拉维德奥尼乌蒂的“莫尔吉亚-佩拉西尼”医院（Parkinson 疾病、运动障碍和脑损伤康复系）。
纳入 60 例住院 PD 合并 FOG 患者，Hoehn 和 Yahr 分期 2 或 5-3 期。
60 例 PD 合并 FOG 患者随机分为 2 组：30 例接受为期 4 周的 MIRT，30 例接受为期 4 周的 MIRT-AT。
主要结局测量指标为冻结步态问卷；次要结局测量指标为统一帕金森病评定量表（UPDRS）总分、UPDRS II、UPDRS III、伯格平衡量表、计时起立行走测试和 6 分钟步行测试。这些指标在入院时和出院时进行评估。
2 组患者年龄、性别分布、Hoehn 和 Yahr 分期和优势侧均相似。基线时，2 组间各项指标无差异。治疗后，2 组所有指标均有显著的时间效应，但无时间×组间交互效应。组间分析显示，2 组间各变量 T1 与 T0 值无差异。
缺乏对照组和随访。
我们发现，多学科、强化、基于目标的康复治疗，如 MIRT，可改善 PD 患者的 FOG。尽管水上治疗可能是治疗 FOG 的一种有用方法，但对这种运动认知康复治疗并无额外获益。
