Center of Health Sciences, Discipline of Physiotherapy, Universidade Federal do Espírito Santo, Vitória, Brazil.
Center of Health Sciences, Discipline of Physiotherapy, Universidade Federal do Espírito Santo, Vitória, Brazil.
J Physiother. 2024 Jul;70(3):208-215. doi: 10.1016/j.jphys.2024.06.004. Epub 2024 Jun 18.
QUESTIONS: In people with Parkinson's disease, what is the effect of adding external cueing (ie, visual, auditory or somatosensorial cueing) to walking training compared with walking training alone in terms of walking, mobility, balance, fear of falling and freezing? Are any benefits carried over to participation or maintained beyond the intervention period? DESIGN: Systematic review of randomised trials with meta-analysis. PARTICIPANTS: Ambulatory adults with Parkinson's disease. INTERVENTION: Walking training with external cueing compared with walking training without external cueing. OUTCOME MEASURES: Walking (ie, speed, stride length and cadence), mobility, balance, fear of falling, freezing and participation. RESULTS: Ten trials involving a total of 309 participants were included. The mean PEDro score of the included trials was 5 (range 4 to 8). Walking training with auditory cueing improved walking speed by 0.09 m/s (95% CI 0.02 to 0.15) more than walking training alone. Although the best estimate was that auditory cueing may also improve stride length by 5 cm, this estimate was imprecise (95% CI -2 to 11). The addition of visual cueing to walking training did not improve walking speed or stride length. Results regarding cadence, mobility, balance, fear of falling, and freezing and maintenance of benefits beyond the intervention period remain uncertain. CONCLUSION: This systematic review provided low-quality evidence that walking training with auditory cueing is more effective than walking training alone for improving walking speed in Parkinson's disease. Cueing is an inexpensive and easy to implement intervention, so the mean estimate might be considered clinically worthwhile, although the confidence interval spans clinically trivial and worthwhile effects. REGISTRATION: PROSPERO CRD42021255065.
问题:在帕金森病患者中,与单独进行行走训练相比,行走训练中加入外部提示(即视觉、听觉或体感提示)在行走、活动能力、平衡、跌倒恐惧和冻结方面有何效果?任何益处是否会持续到干预期之外或得到维持?
设计:随机试验的系统评价和荟萃分析。
参与者:有行走能力的帕金森病成年人。
干预:带外部提示的行走训练与不带外部提示的行走训练。
结局测量:行走(即速度、步长和步频)、活动能力、平衡、跌倒恐惧、冻结和参与度。
结果:纳入了 10 项共涉及 309 名参与者的试验。纳入试验的平均 PEDro 评分为 5 分(范围为 4 至 8 分)。与单独进行行走训练相比,带听觉提示的行走训练可使行走速度提高 0.09 米/秒(95%置信区间 0.02 至 0.15)。尽管最佳估计是听觉提示也可能使步长增加 5 厘米,但这一估计并不精确(95%置信区间-2 至 11)。将视觉提示加入行走训练并不能提高行走速度或步长。关于步频、活动能力、平衡、跌倒恐惧以及干预期后益处的维持,结果仍不确定。
结论:本系统评价提供了低质量证据,表明与单独进行行走训练相比,带听觉提示的行走训练更能有效提高帕金森病患者的行走速度。提示是一种廉价且易于实施的干预措施,因此,平均估计值可能被认为具有临床意义,但置信区间涵盖了临床微不足道和有意义的效果。
注册:PROSPERO CRD42021255065。
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