四周躯干特异性运动方案可降低帕金森病患者的前躯干屈曲：一项单盲、随机对照试验。
Four-week trunk-specific exercise program decreases forward trunk flexion in Parkinson's disease: A single-blinded, randomized controlled trial.
机构信息
Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; UOC Neurorehabilitation, AOUI Verona, Italy.
Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
出版信息
Parkinsonism Relat Disord. 2019 Jul;64:268-274. doi: 10.1016/j.parkreldis.2019.05.006. Epub 2019 May 3.
INTRODUCTION
Pathological forward trunk flexion is a disabling and drug-refractory motor complication of Parkinson's disease (PD) leading to imbalance, pain, and fall-related injuries. Since it might be reversible, early and multidisciplinary management is emphasised. The primary aim was to compare the effects of a four-week trunk-specific rehabilitation program on the severity of the forward trunk flexion. The secondary aim was to compare the training effects on the motor impairments, dynamic and static balance, pain, falls, and quality of life.
METHODS
37 patients with PD (H&Y ≤ 4) and forward trunk flexion were randomized in the experimental (n = 19) or control group (n = 18). The former consisted of active self-correction exercises with visual and proprioceptive feedback, passive and active trunk stabilization exercises and functional tasks. The latter consisted of joint mobilization, muscle strengthening and stretching, gait and balance exercises. Protocols lasted 4 weeks (60 min/day, 5 days/week). Before, after, and at 1-month follow-up, a blinded examiner evaluated patients using primary and secondary outcomes. The primary outcome was the forward trunk flexion severity (degree). Secondary outcomes were the UPDRS III, dynamic and static balance, pain falls, and quality of life assessment.
RESULTS
The experimental group reported a significantly greater reduction in forward trunk flexion than the control group from T0 to both T1 (p = 0.003) and T2 (p = 0.004). The improvements in dynamic and static balance were significantly greater for the experimental group than the control group from T0 to T2 (p = 0.017 and 0.004, respectively). Comparable effects were reported on the other outcomes. Pre-treatment forward trunk flexion values were highly correlated to post-treatment trunk deviation changes.
CONCLUSION
The four-week trunk-specific rehabilitation training decreased the forward trunk flexion severity and increased postural control in patients with PD. NCT03741959.
简介
病理性躯干前屈是一种导致失衡、疼痛和与跌倒相关损伤的致残性、药物难治性帕金森病（PD）运动并发症。由于其可能具有可逆性，因此强调早期和多学科管理。主要目的是比较为期四周的躯干特异性康复方案对前屈躯干严重程度的影响。次要目的是比较训练对运动障碍、动态和静态平衡、疼痛、跌倒和生活质量的影响。
方法
37 例 PD 患者（H&Y ≤ 4 且存在前屈躯干）被随机分为实验组（n=19）或对照组（n=18）。前者包括主动自我纠正练习、视觉和本体感觉反馈、被动和主动躯干稳定练习以及功能任务。后者包括关节松动术、肌肉强化和伸展、步态和平衡练习。方案持续 4 周（60 分钟/天，每周 5 天）。在基线、治疗后和 1 个月随访时，盲法评估者使用主要和次要结局评估患者。主要结局是前屈躯干严重程度（度）。次要结局包括 UPDRS III、动态和静态平衡、疼痛、跌倒和生活质量评估。
结果
与对照组相比，实验组从 T0 到 T1（p=0.003）和 T2（p=0.004），前屈躯干严重程度显著降低。与对照组相比，实验组在 T0 到 T2 期间动态和静态平衡的改善更为显著（p=0.017 和 0.004）。其他结局也有类似的效果。治疗前前屈躯干值与治疗后躯干偏斜变化高度相关。
结论
为期四周的躯干特异性康复训练可降低 PD 患者前屈躯干的严重程度，提高姿势控制能力。NCT03741959。
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