综合认知与平衡训练对小脑共济失调患者平衡能力及跌倒预防的有效性和成本：一项双盲双臂平行组随机对照试验
Effectiveness and cost of integrated cognitive and balance training for balance and falls in cerebellar ataxia: a blinded two-arm parallel group RCT.
作者信息
Winser Stanley J, Chan Anne Y Y, Whitney Susan L, Chen Cynthia H, Pang Marco Y C
机构信息
Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China.
Division of Neurology, Prince of Wales Hospital and Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China.
出版信息
Front Neurol. 2024 Jan 19;14:1267099. doi: 10.3389/fneur.2023.1267099. eCollection 2023.
BACKGROUND
In patients with cerebellar ataxia (CA), dual-tasking deteriorates the performance of one or both tasks.
OBJECTIVE
Evaluate the effects of 4 weeks of cognitive-coupled intensive balance training (CIBT) on dual-task cost, dynamic balance, disease severity, number of falls, quality of life, cognition and cost among patients with CA.
METHODS
This RCT compared CIBT (Group 1) to single-task training (Group 2) among 32 patients with CA. The intervention included either dual-task (CIBT) or single-task training for 4 weeks followed by 6 months of unsupervised home exercises. Dual-task timed up-and-go test (D-TUG) assessed dual-task cost of the physical and cognitive tasks. Assessment time points included baseline 1 (Week 0:T1), baseline 2 (Week 6:T2), post-intervention (Week 10:T3), and follow-up (Week 34:T4).
RESULTS
Compared to single-task training CIBT improved the dual-task cost of physical task [MD -8.36 95% CI (-14.47 to -2.36, < 0.01), dual-tasking ability [-6.93 (-13.16 to -0.70); = 0.03] assessed using D-TUG, balance assessed using the scale for the assessment and rating of ataxia (SARAbal) [-2.03 (-4.04 to -0.19); = 0.04], visual scores of the SOT (SOT-VIS) [-18.53 (-25.81 to -11.24, ≤ 0.01] and maximal excursion [13.84 (4.65 to 23.03; ≤ 0.01] of the Limits of Stability (LOS) in the forward direction and reaction time in both forward [-1.11 (-1.42 to -0.78); < 0.01] and right [-0.18 (0.05 to 0.31); < 0.01] directions following 4 weeks of training. CIBT did not have any additional benefits in reducing the number of falls, or improving disease severity, quality of life and cognition. The mean cost of intervention and healthcare costs for 7 months was HKD 33,380 for CIBT group and HKD 38,571 for single-task training group.
CONCLUSION
We found some evidence to support the use of CIBT for improving the dual-tasking ability, dual-task cost of physical task and dynamic balance in CA. Future large fully-powered studies are needed to confirm this claim.
CLINICAL TRIAL REGISTRATION
https://clinicaltrials.gov/study/NCT04648501, identifier [Ref: NCT04648501].
背景
在小脑共济失调（CA）患者中，同时执行两项任务会使一项或两项任务的表现变差。
目的
评估4周的认知耦合强化平衡训练（CIBT）对CA患者双任务成本、动态平衡、疾病严重程度、跌倒次数、生活质量、认知和成本的影响。
方法
本随机对照试验将32例CA患者分为CIBT组（第1组）和单任务训练组（第2组）。干预措施包括为期4周的双任务（CIBT）或单任务训练，随后进行6个月无人监督的家庭锻炼。双任务计时起立行走测试（D-TUG）评估身体和认知任务的双任务成本。评估时间点包括基线1（第0周：T1）、基线2（第6周：T2）、干预后（第10周：T3）和随访（第34周：T4）。
结果
与单任务训练相比，CIBT改善了身体任务的双任务成本[MD -8.36，95%CI（-14.47至-2.36），P<0.01]、使用D-TUG评估的双任务能力[-6.93（-13.16至-0.70）；P = 0.03]、使用共济失调评估和评分量表（SARAbal）评估的平衡[-2.03（-4.04至-0.19）；P = 0.04]、感觉组织测试的视觉分数（SOT-VIS）[-18.53（-25.81至-11.24），P≤0.01]以及向前方向的稳定极限（LOS）的最大偏移[13.84（4.65至23.03）；P≤0.01]，以及训练4周后向前[-1.11（-1.42至-0.78）；P<0.01]和向右[-0.18（0.05至0.31）；P<0.01]方向的反应时间。CIBT在减少跌倒次数、改善疾病严重程度、生活质量和认知方面没有任何额外益处。CIBT组7个月的干预平均成本和医疗保健成本为33,380港元，单任务训练组为38,571港元。
结论
我们发现一些证据支持使用CIBT来提高CA患者的双任务能力、身体任务的双任务成本和动态平衡。未来需要进行大规模的充分有力的研究来证实这一说法。
临床试验注册
https://clinicaltrials.gov/study/NCT04648501，标识符[参考文献：NCT04648501]
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