Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
J Altern Complement Med. 2019 Dec;25(12):1225-1237. doi: 10.1089/acm.2019.0148. Epub 2019 Sep 26.
Falls are common in Parkinson's disease (PD). Exercise interventions can prevent falls. This review aims to (1) explore the existing evidence regarding the cost-effectiveness of exercise-based fall prevention programs for people with PD and (2) discuss the implications of the review findings for future research and clinical practice. Databases AMED Allied and Complementary Medicine, CINAHL, CRD, EBSCO, EMBASE, MEDLINE, PubMed, Scopus, and Web of Science were searched from their inception until June 2019. Randomized and nonrandomized trials that included an economic evaluation of fall prevention programs for people with PD were considered. Quality of the economic evaluation was assessed using the Consensus on Health Economic Criteria list (CHEC-list), and the methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) and Cochrane risk of bias tool. Nine hundred and sixty-five studies were screened to include three studies involving 556 participants. Quality of economic evaluation assessed using CHEC-list was high. The methodological quality was high for two studies and low for one study. Tested interventions included Tai Ji Quan, physiotherapist-led, supervised, weekly and monthly balance, and strengthening exercises. The duration of the interventions ranged from 10 weeks to 6 months, while the intervention frequency ranged from two sessions per week to one session per month. Treatment sessions lasted for 60 min in all three studies. One high economic and methodological quality study comparing Tai Ji Quan with resistance and stretching exercises reported least cost resource use among Tai Ji Quan group (USD 80,441) and greater incremental number of falls prevented. All three tested interventions had an 80% probability of being cost-effective with the corresponding country-specific threshold incremental cost-effectiveness ratio values. The findings provide some evidence for exercise-based intervention as a cost-effective treatment option for preventing falls in PD; however, due to the limited number of available studies, heterogeneity of the interventions, and diversity of assessment settings, a firm conclusion cannot be established. Additional studies evaluating the cost-effectiveness of fall prevention programs involving larger samples and using different treatment parameters in various settings are warranted.
帕金森病（PD）患者常发生跌倒。运动干预可预防跌倒。本综述旨在：（1）探讨针对 PD 患者的基于运动的防跌倒计划的现有成本效益证据；（2）讨论本综述结果对未来研究和临床实践的意义。 从建库起至 2019 年 6 月，检索 AMED 联合补充医学、CINAHL、CRD、EBSCO、EMBASE、MEDLINE、PubMed、Scopus 和 Web of Science 数据库。纳入包含 PD 患者防跌倒计划的经济评估的随机和非随机试验。使用共识健康经济标准清单（CHEC-list）评估经济评估的质量，使用物理治疗证据数据库（PEDro）和 Cochrane 偏倚风险工具评估方法学质量。 共筛选出 965 项研究，纳入了三项涉及 556 名参与者的研究。使用 CHEC-list 评估的经济评估质量较高。两项研究的方法学质量较高，一项研究的方法学质量较低。所测试的干预措施包括太极拳、物理治疗师主导的、监督的、每周和每月的平衡和力量训练。干预的持续时间从 10 周到 6 个月不等，干预频率从每周两次到每月一次不等。所有三项研究的治疗时间均为 60 分钟。一项高质量经济和方法学研究比较了太极拳与阻力和拉伸运动，报告了太极拳组的最低资源使用成本（80441 美元）和预防跌倒的增量数量最大。所有三项测试的干预措施都有 80%的概率具有成本效益，相应的国家特定增量成本效益比的价值。 这些发现为基于运动的干预作为 PD 患者预防跌倒的一种具有成本效益的治疗选择提供了一些证据；然而，由于可用研究数量有限、干预措施的异质性以及评估环境的多样性，无法得出明确的结论。需要进一步的研究来评估涉及更大样本和在不同环境中使用不同治疗参数的防跌倒计划的成本效益。
