Miyahara Yuka, Phokaewvarangkul Onanong, Kerr Stephen, Anan Chanawat, Toriumi Haruki, Bhidayasiri Roongroj
Doctor of Philosophy Program in Medical Sciences (International Program), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Front Neurol. 2024 Jan 29;15:1327448. doi: 10.3389/fneur.2024.1327448. eCollection 2024.
ON-freezing of gait (ON-FOG) in Parkinson's disease (PD), often resistant to medication, is linked to sensory deficits and proprioceptive impairment, and results in falls and reduced life quality. While visual cues from a laser cane (LC), which rapidly accesses the motor cortex, are commonly used to compensate for proprioceptive impairment, increased visual reliance may be affected by disease progression. Emerging evidence suggests that modulation of peripheral sensory processing may alleviate ON-FOG, and therapeutic Thai acupressure (TTA) may be a solution. This study aims to evaluate the effect of TTA in alleviating ON-FOG and compare its effectiveness to LC in patients with PD.
This open-label, non-inferiority trial randomized 90 PD patients with ON-FOG equally into three arms: TTA for plantar nerve stimulation for 96 s, LC for visual cueing, and sham control (SC). Stride length was the primary non-inferiority endpoint [non-inferiority margin: lower limit of 95% confidence interval (CI) above -10 cm in mean change difference in pre- and immediately post-intervention in TTA versus LC (one-sided)]. Secondary outcomes included FOG episodes, double support time, velocity, cadence, step length, timed up and go (TUG) test, and visual analog scale (VAS) score.
TTA showed non-inferiority to LC in stride length (mean = -0.7 cm; 95% CI: -6.55; 5.15) (one-sided). The improvements with TTA and LC versus SC were comparable between (mean = 13.11 cm; 95% CI: 7.26; 18.96) and (mean = 13.8 cm; 95% CI: 7.96; 19.65) (one-sided). Secondary outcomes favored TTA and LC over SC with improved FOG, velocity, step length, and VAS scores, while only TTA resulted in improved double support time, cadence, and TUG test results. No complications occurred.
The efficacy of TTA, which improves stride length, is non-inferior to that of LC and consequently alleviates FOG comparable to LC. TTA might enhance proprioceptive function and reduce visual dependence. Therefore, TTA, characterized by its non-invasive, simple, and safe techniques, is a potential non-pharmacological alternative for ON-FOG treatment and might enhance overall quality of life. However, further research into the mechanism, efficacy, and utilization of TTA is essential.
https://www.thaiclinicaltrials.org/show/TCTR20200317001, identifier TCTR20200317001.
帕金森病（PD）中的冻结步态（ON - FOG）通常对药物治疗有抵抗性，与感觉缺陷和本体感觉障碍有关，会导致跌倒并降低生活质量。虽然来自激光手杖（LC）的视觉线索可快速作用于运动皮层，常用于补偿本体感觉障碍，但视觉依赖的增加可能会受到疾病进展的影响。新出现的证据表明，调节外周感觉处理可能会减轻ON - FOG，而治疗性泰式指压（TTA）可能是一种解决方案。本研究旨在评估TTA在减轻PD患者ON - FOG方面的效果，并将其与LC的有效性进行比较。
这项开放标签、非劣效性试验将90例患有ON - FOG的PD患者随机分为三组：进行96秒足底神经刺激的TTA组、提供视觉线索的LC组和假对照（SC）组。步长是主要的非劣效性终点[非劣效性界值：TTA组与LC组干预前和干预后即刻平均变化差异的95%置信区间（CI）下限高于 -10 cm（单侧）]。次要结局包括FOG发作次数、双支撑时间、速度、步频、步长、计时起立行走（TUG）测试和视觉模拟量表（VAS）评分。
TTA在步长方面显示出不劣于LC（均值 = -0.7 cm；95% CI：-6.55；5.15）（单侧）。TTA组和LC组相对于SC组的改善相当（均值 = 13.11 cm；95% CI：7.26；18.96）和（均值 = 13.8 cm；95% CI：7.96；19.65）（单侧）。次要结局显示，与SC组相比，TTA组和LC组在FOG、速度、步长和VAS评分方面有所改善，而只有TTA组双支撑时间、步频和TUG测试结果得到改善。未发生并发症。
TTA改善步长的疗效不劣于LC，因此在减轻FOG方面与LC相当。TTA可能会增强本体感觉功能并减少视觉依赖。因此，以其非侵入性、简单和安全的技术为特点，TTA是ON - FOG治疗的一种潜在非药物替代方法，可能会提高整体生活质量。然而，对TTA的机制、疗效和应用进行进一步研究至关重要。
https://www.thaiclinicaltrials.org/show/TCTR20200317001，标识符TCTR20200317001。
