Effects of different percentages of body weight-supported treadmill training in Parkinson's disease: a double-blind randomized controlled trial

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Abstract

Background/aim

Body weight-supported treadmill training (BWSTT) might have greater effects than conventional treadmill training (TT) in neurological diseases such as Parkinson's disease (PD). The aim of this study was to evaluate the effects of different percentages of BWSTT on gait, balance, quality of life, and fatigue in PD.

Materials and methods

Thirty-five patients with moderate to advanced PD were randomized into three BWSTT groups according to the supported percentage of body weight: 0% BWSTT (control group; unsupported TT), 10% BWSTT, or 20% BWSTT. Five patients were excluded due to early discharge and 30 patients completed BWSTT sessions lasting 30 min, 5 days a week, for 6 weeks during their inpatient rehabilitation stay. The primary outcome was 6-min walk distance (6MWD). Secondary outcomes were Unified Parkinson's Disease Rating Scale (UPDRS), Berg Balance Scale (BBS), Nottingham Health Profile (NHP), Fatigue Impact Scale, and Fatigue Severity Scale scores. Measurements were performed before and after the training.

Results

The unsupported TT group demonstrated no significant improvement in the outcome measures after a 6-week training except for BBS and NHP emotional subscores. Moreover, the NHP pain subscore increased in the unsupported TT group after training. The 10% and 20% supported BWSTT groups demonstrated significant improvements in 6MWD (P = 0.004 and P < 0.001, respectively), UPDRS - motor score (P = 0.012 and P = 0.005, respectively), NHP pain subscore (P = 0.003 and P = 0.002, respectively), and fatigue (P = 0.005 for both) after training. The 20% BWSTT provided the highest improvement in balance among the three groups (P < 0.001) and greater relief of fatigue than 10% BWSTT (P = 0.002).

Conclusion

Six weeks of BWSTT improved walking distance and balance ability, relieved fatigue, and additionally reduced pain in patients with moderate to advanced PD.

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Most cited references 27

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Usefulness of the Berg Balance Scale in stroke rehabilitation: a systematic review.

Lisa M. Blum, Nicol Korner-Bitensky (2008)

In a recent study of 655 physical therapists working with a stroke population, the Berg Balance Scale (BBS) was identified as the most commonly used assessment tool across the continuum of stroke rehabilitation. Given the widespread popularity of the BBS, it is important to critically appraise the BBS for its use with a stroke population. The purposes of this study were to conduct a systematic review of the psychometric properties of the BBS specific to stroke and to identify strengths and weaknesses in its usefulness for stroke rehabilitation. Twenty-one studies examining the psychometric properties of the BBS with a stroke population were retrieved. Internal consistency was excellent (Cronbach alpha=.92-.98) as was interrater reliability (intraclass correlation coefficients [ICCs]=.95-.98), intrarater reliability (ICC=.97), and test-retest reliability (ICC=.98). Sixteen studies focused on validity and generally found excellent correlations with the Barthel Index, the Postural Assessment Scale for Stroke Patients, Functional Reach Test, the balance subscale of Fugl-Meyer Assessment, the Functional Independence Measure, the Rivermead Mobility Index (except for weight shift and step-up items), and gait speed. Berg Balance Scale scores predicted length of stay, discharge destination, motor ability at 180 days poststroke, and disability level at 90 days, but these scores were not predictive of falls. Eight studies focused on responsiveness; all reported moderate to excellent sensitivity. Three studies found floor or ceiling effects. The BBS is a psychometrically sound measure of balance impairment for use in poststroke assessment. Given the floor and ceiling effects, clinicians may want to use the BBS in conjunction with other balance measures.

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Measuring the functional impact of fatigue: initial validation of the fatigue impact scale.

Mary Ross, William Fisk, P Ritvo … (1993)

The fatigue impact scale (FIS) was developed to improve our understanding of the effects of fatigue on quality of life. The FIS examines patients' perceptions of the functional limitations that fatigue has caused over the past month. FIS items reflect perceived impact on cognitive, physical, and psychosocial functioning. This study compared 145 patients referred for investigation of chronic fatigue (ChF) with 105 patients with multiple sclerosis (MS) and 34 patients with mild hypertension (HT). Internal consistency for the FIS and its three subscales was > .87 for all analyses. Fatigue impact was highest for the ChF group although the MS group's reported fatigue also exceeded that of the HT group. Discriminant function analysis correctly classified 80.0% of the ChF group and 78.1% of the MS group when these groups were compared. This initial validation study indicates that the FIS has considerable merit as a measure of patient's attribution of functional limitations to symptoms of fatigue.

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Rehabilitation for Parkinson's disease: Current outlook and future challenges.

Giovanni Abbruzzese, Roberta Marchese, Laura Avanzino … (2016)

Rehabilitation is considered as an adjuvant to pharmacological and surgical treatments for Parkinson's disease (PD) to maximize functional ability and minimize secondary complications. Originally, approaches were based on empirical experience, but growing evidence suggests that exercise-dependent plasticity constitutes the main mechanism underlying the effects of physiotherapy. Exercise increases synaptic strength and influences neurotransmission, thus potentiating functional circuitry in PD. In addition, exercise is a pivotal element of motor learning. PD patients retain a sufficient capacity of motor learning, though learning rates and performance are reduced in comparison to normal controls. Recent meta-analyses demonstrated that rehabilitation could induce short-lasting, but clinically important benefits, particularly for gait and balance. However, the interventions are largely heterogeneous (stretching, muscle strengthening, balance, postural exercises, occupational therapy, cueing, treadmill training), and there is still no consensus about the optimal approach. Innovative techniques have been recently proposed: virtual reality and exergaming, motor imagery and action observation, robot-assisted physiotherapy and non-conventional therapies (e.g.: dance, martial arts). The rehabilitative program for PD should be "goal-based" (targeted to practicing and learning specific activities in the core areas), but a number of practice variables (intensity, specificity, complexity) need to be identified and the program should tailored to the individual patients' characteristics.

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Author and article information

Journal

Journal ID (nlm-ta): Turk J Med Sci

Journal ID (iso-abbrev): Turk J Med Sci

Title: Turkish Journal of Medical Sciences

Publisher: The Scientific and Technological Research Council of Turkey

ISSN (Print): 1300-0144

ISSN (Electronic): 1303-6165

Publication date Collection: 2019

Publication date (Electronic): 08 August 2019

Volume: 49

Issue: 6

Pages: 999-1007

Affiliations

[1 ] Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Hitit University, Çorum Turkey

[2 ] Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Koç University, İstanbul Turkey

[3 ] Department of Neurology, Faculty of Medicine, Gazi University, Ankara Turkey

[4 ] Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Gazi University, Ankara Turkey

[5 ] Department of Neurology, 29 Mayıs Public Hospital, Ankara Turkey

[6 ] Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Gazi University, Ankara Turkey

Author notes

* To whom correspondence should be addressed. E-mail: tubaatan@ 123456gmail.com

CONFLICT OF INTEREST:

none declared

Author information

Tuğba ATAN https://orcid.org/0000-0003-1229-8679

Özden ÖZYEMİŞCİ TAŞKIRAN https://orcid.org/0000-0002-2052-6072

Ayşe BORA TOKÇAER https://orcid.org/0000-0003-4363-724X

Gülçin KAYMAK KARATAŞ https://orcid.org/0000-0001-5117-3911

Aslı KARAKUŞ ÇALIŞKAN https://orcid.org/0000-0002-4786-2076

Belgin KARAOĞLAN https://orcid.org/0000-0002-9152-703X

Article

DOI: 10.3906/sag-1812-57

PMC ID: 7018238

PubMed ID: 31292107

SO-VID: 9f7dbb25-4c72-4cb9-aacb-995f4e7bd436

License:

This article is distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use and redistribution provided that the original author and source are credited.

Effects of different percentages of body weight-supported treadmill training in Parkinson's disease: a double-blind randomized controlled trial

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Abstract

Background/aim

Materials and methods

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Karger: Neurology and Neuroscience

Most cited references 27

Usefulness of the Berg Balance Scale in stroke rehabilitation: a systematic review.

Measuring the functional impact of fatigue: initial validation of the fatigue impact scale.

Rehabilitation for Parkinson's disease: Current outlook and future challenges.

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