在帕金森病患者中,通过听觉提示进行步行训练比单独进行步行训练更能提高步行速度:一项系统性综述。

IF 9.7 1区 医学 Q1 ORTHOPEDICS Journal of Physiotherapy Pub Date : 2024-07-01 DOI:10.1016/j.jphys.2024.06.004
Lucas R Nascimento , Augusto Boening , Rafaela JS Rocha , Willian A do Carmo , Louise Ada
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引用次数: 0

摘要

问题对帕金森病患者而言,在步行训练中加入外部提示(即视觉、听觉或体感提示)与单独进行步行训练相比,在步行、移动性、平衡、跌倒恐惧和僵直方面有何效果?任何益处是否会在干预期结束后延续或保持?随机试验的系统回顾与荟萃分析:干预:干预措施:有外部提示的步行训练与无外部提示的步行训练比较:结果:步行(即速度、步幅和步频)、活动能力、平衡能力、跌倒恐惧感、冻结感和参与度:结果:共纳入 10 项试验,涉及 309 名参与者。所纳入试验的平均 PEDro 得分为 5(范围为 4 至 8)。与单独进行步行训练相比,通过听觉提示进行步行训练后,步行速度提高了 0.09 米/秒(95% CI 0.02 至 0.15)。虽然最好的估计是听觉提示也能将步长提高 5 厘米,但这一估计并不精确(95% CI -2-11)。在步行训练中加入视觉提示并不能提高步行速度或步幅。关于步速、活动能力、平衡能力、跌倒恐惧以及干预期结束后效益的冻结和维持等方面的结果仍不确定:本系统综述提供了低质量的证据,证明在提高帕金森病患者步行速度方面,听觉提示下的步行训练比单独的步行训练更有效。提示是一种成本低廉、易于实施的干预措施,因此,尽管置信区间跨越了临床上微不足道的效果和有价值的效果,但平均估计值仍可被视为具有临床价值:注册号:PREMCORD42021255065。
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Walking training with auditory cueing improves walking speed more than walking training alone in ambulatory people with Parkinson’s disease: a systematic review

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.

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来源期刊
Journal of Physiotherapy
Journal of Physiotherapy ORTHOPEDICS-REHABILITATION
CiteScore
11.40
自引率
7.40%
发文量
69
审稿时长
72 days
期刊介绍: The Journal of Physiotherapy is the official journal of the Australian Physiotherapy Association. It aims to publish high-quality research with a significant impact on global physiotherapy practice. The journal's vision is to lead the field in supporting clinicians to access, understand, and implement research evidence that will enhance person-centred care. In January 2008, the Journal of Physiotherapy became the first physiotherapy journal to adhere to the ICMJE requirement of registering randomized trials with a recognized Trial Registry. The journal prioritizes systematic reviews, clinical trials, economic analyses, experimental studies, qualitative studies, epidemiological studies, and observational studies. In January 2014, it also became the first core physiotherapy/physical therapy journal to provide free access to editorials and peer-reviewed original research. The Australian Physiotherapy Association extended their support for excellence in physiotherapy practice by sponsoring open access publication of all Journal of Physiotherapy content in 2016. As a result, all past, present, and future journal articles are freely accessible, and there are no author fees for publication.
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