家庭物理治疗与远程康复在改善帕金森病患者运动功能和生活质量方面的比较：一项随机对照试验。

Home physical therapy versus telerehabilitation in improving motor function and quality of life in Parkinson's disease: a randomized controlled trial.

机构信息

Department of Rehabilitation Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China.

Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China.

出版信息

BMC Geriatr. 2024 Nov 22;24(1):968. doi: 10.1186/s12877-024-05529-6.

DOI:10.1186/s12877-024-05529-6

PMID:39578754

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11583509/

Abstract

BACKGROUND

Over the past few years, the development of telerehabilitation has advanced rapidly. Patients with Parkinson's disease (PwPD) often have difficulty with mobility, making it challenging for them to perform centre-based exercise.This study aims to compare the effectiveness and adherence of home physical therapy (HPT) and telerehabilitation (TR) in mitigating motor symptoms and improving the quality of life in patients with mild to moderate Parkinson's disease.

METHODS

This randomized controlled trial included a total of 190 patients who underwent in-person eligibility assessment, with 100 allocated to the HPT group and 90 to the TR group. Both interventions consisted of home-based training sessions lasting 40-60 min and were conducted five times a week for 4 weeks. The primary outcome was the Unified Parkinson's Disease Rating Scale motor section (UPDRS3) score. Secondary outcomes included balance function, assessed using the Berg Balance Scale (BBS); risk of fall, evaluated through the Timed Up-and-Go test (TUG) and the Five Times Sit-to-Stand test (FTSST); gait, measured using the Freezing of Gait Questionnaire (FOGQ) and IDEEA activity monitor; muscle strength, evaluated using the isokinetic dynamometry; motor aspects of experiences of daily living (UPDRS2); and quality of life, assessed by Parkinson's Disease Questionnaire-39 (PDQ-39).

RESULTS

There was a significant difference in the UPDRS3, BBS, TUG, FTSST, FOGQ,step length, step velocity,preswing angle, UPDRS2 and PDQ-39 between baseline and 4 weeks in both groups. The decrease in the UPDRS3 score was significantly greater in the HPT group (-3.38 points) than in the RE group (-1.45 points) in the older age group (P = 0.021), but there was no significant between-group difference in the younger age group (P = 0.416). Similar changes favouring the HPT group were observed in the BBS, TUG, step velocity, and extension average torque. 7 (7%) patients in the HPT group and 12 (13%) patients in the TR group did not complete their daily exercise plan.

CONCLUSIONS

Both HPT and TR have demonstrated effectiveness, safety, and feasibility in PwPD. However, the HPT program exhibited greater effectiveness among older patients and higher patient compliance compared to TR.

TRIAL REGISTRATION

Chictr.org.cn, ChiCTR2300071648. Registered on 22 May 2023-retrospectively registered, https://www.chictr.org.cn/showproj.html?proj=196313 .

摘要

背景

在过去的几年中，远程康复技术得到了迅速发展。患有帕金森病（PD）的患者通常存在移动困难的问题，这使得他们难以进行以中心为基础的运动训练。本研究旨在比较家庭物理治疗（HPT）和远程康复（TR）在减轻运动症状和改善轻度至中度帕金森病患者生活质量方面的有效性和依从性。

方法

这是一项随机对照试验，共纳入 190 名患者进行了现场资格评估，其中 100 名患者被分配到 HPT 组，90 名患者被分配到 TR 组。这两种干预措施都包括在家进行的 40-60 分钟的训练课程，每周进行 5 次，持续 4 周。主要结局指标是统一帕金森病评定量表运动部分（UPDRS3）评分。次要结局指标包括平衡功能，使用 Berg 平衡量表（BBS）评估；跌倒风险，通过计时起立行走测试（TUG）和五次坐立站起测试（FTSST）评估；步态，使用冻结步态问卷（FOGQ）和 IDEEA 活动监测仪评估；肌肉力量，使用等速测力计评估；日常生活活动的运动方面（UPDRS2）；以及生活质量，使用帕金森病问卷-39（PDQ-39）评估。

结果

两组患者在基线和 4 周时的 UPDRS3、BBS、TUG、FTSST、FOGQ、步长、步速、预摆角度、UPDRS2 和 PDQ-39 均有显著差异。在年龄较大的患者中，HPT 组（-3.38 分）的 UPDRS3 评分下降明显大于 TR 组（-1.45 分）（P=0.021），但在年龄较小的患者中，两组间无显著差异（P=0.416）。在 BBS、TUG、步速和平均伸展扭矩方面，HPT 组也观察到了类似的、有利于 HPT 组的变化。HPT 组有 7（7%）名患者和 TR 组有 12（13%）名患者未完成日常锻炼计划。