Iucksch Dielise Debona, Siega Juliana, Leveck Giovanna Cristina, de Araujo Luize Bueno, Mélo Tainá Ribas, Israel Vera Lúcia
Postgraduation Program in Physical Education, Federal University of Paraná, Curitiba 82590-300, Brazil.
Postgraduation Program in Public Health, Federal University of Paraná, Curitiba 80060-240, Brazil.
Rehabil Res Pract. 2023 Jan 9;2023:2762863. doi: 10.1155/2023/2762863. eCollection 2023.
Parkinson's disease (PD) is a neurodegenerative, with heterogeneous clinical conditions and motor changes that reduce functioning. Postural instability is one of the motor aspects of disease progression, with a potential increase in the risk of falls, consequently affecting the activities of daily living (ADL). The objective of this study was to verify the influence of a multimodal intervention program (MIP) sequentially applied in aquatic- (AEs) and land-based environments (LEs) on balance, postural control, motor activities, and ADL in people with PD. It is an interventional clinical study with patients in stages 1 to 4 in the Hoehn and Yahr scale, assessed with Berg Balance Scale (BBS), Mini-Balance Evaluation System Test (Mini-BESTest), Unified Parkinson's Disease Rating Scale (UPDRS) II and III, Dynamic Gait Index (DGI), and quiet stance (QS) analysis in a force platform. The MIP was conducted sequentially with aquatic- (AIs) and land-based interventions (LIs) for 12 weeks each, twice a week, each session lasting 1 hour, and a 12-week interval between interventions. The comparison analysis was made with Friedman ANOVA, and the multiple comparisons with Wilcoxon signed-rank, Bonferroni correction, and effect size (). The sample comprised 18 people with PD (66.83 ± 11.74 years). The AI and the full intervention (FI) had a large effect according to BBS. With Mini-BESTest, the LI and FI had a large effect. According to UPDRS II, the MIP improved ADL after LI, with a medium effect, and the motor aspects of UPDRS III improved after LI and FI, with a large effect. DGI was not sensitive in the analyses, with a ceiling effect after FI. No differences were identified in QS analyses. This research identified improved balance, ADL, and motor aspects in people with PD after sequential MIP in AI and LI, indicating that land-based and aquatic interventions are complementary and advantageous to people with PD.
帕金森病（PD）是一种神经退行性疾病，临床症状多样，运动功能改变会降低生活能力。姿势不稳是疾病进展的运动表现之一，跌倒风险可能增加，进而影响日常生活活动（ADL）。本研究的目的是验证在水上（AEs）和陆地环境（LEs）中依次应用的多模式干预计划（MIP）对帕金森病患者平衡、姿势控制、运动活动和ADL的影响。这是一项针对Hoehn和Yahr量表1至4期患者的干预性临床研究，采用伯格平衡量表（BBS）、简易平衡评估系统测试（Mini - BESTest）、统一帕金森病评定量表（UPDRS）II和III、动态步态指数（DGI）以及在测力平台上进行安静站立（QS）分析进行评估。MIP依次进行水上干预（AIs）和陆地干预（LIs），各为期12周，每周两次，每次持续1小时，两次干预之间间隔12周。采用Friedman方差分析进行比较分析，采用Wilcoxon符号秩检验、Bonferroni校正和效应量（）进行多重比较。样本包括18名帕金森病患者（66.83±11.74岁）。根据BBS，AI和全面干预（FI）有较大效果。对于Mini - BESTest，LI和FI有较大效果。根据UPDRS II，MIP在LI后改善了ADL，效果中等，而UPDRS III的运动方面在LI和FI后有较大改善。DGI在分析中不敏感，FI后出现天花板效应。QS分析未发现差异。本研究发现，在AI和LI中依次进行MIP后，帕金森病患者的平衡、ADL和运动方面得到改善，表明陆地和水上干预对帕金森病患者具有互补性且有益。
