T. Capato1,2, J. Nonnekes3, N. de Vries1, J. IntHout4, E.R. Barbosa2, B.R. Bloem1
1Radboud University Medical Center, Neurology, Nijmegen, Netherlands, 2University of São Paulo, Neurology, São Paulo, Brazil, 3Radboud University Medical Center, Rehabilitation, Nijmegen, Netherlands, 4Radboud University Medical Center, Health Evidence, Nijmegen, Netherlands
Background: Non-pharmacological interventions such as physiotherapy are recognized as important elements in the overall clinical management of motor impairments in PD, but evidence of physiotherapy in advanced disease stages is sparse. A recent trial found positive effects of multimodal balance training in people with mild to moderate PD, with greater and more sustained effects when rhythmical auditory stimuli were added. It is unclear whether such multimodal balance training is also effective in people with advanced PD (Hoehn & Yahr stage 4).
Purpose: To study effect of physiotherapy on balance performance in advanced Parkinson’s Disease. Specifically, to study whether effects improve when auditory cues are added to the training.
Methods: We performed a prospective single-blind, randomized clinical trial to study the effectiveness of multimodal training with and without rhythmical auditory stimuli. We screened 76 people with Parkinson’s disease and Hoehn & Yahr stage 4 by telephone; 35 patients were assigned randomly into two groups: (1) multimodal balance training with rhythmical auditory stimuli (RAS-supported intervention, n=17) and (2) multimodal balance training without rhythmical auditory cues (n=18). Training was performed for 5 weeks, two times/week. Primary outcome was the Mini-BESTest (MBEST) score immediately after the training period. Assessments were performed by the same two blinded assessors at baseline, immediately post intervention, and after one and 6-months follow-up.
Results: Immediately post-intervention, both intervention groups improved significantly on Mini-Best scores, without differences between both intervention modalities. In both groups, results were retained at one-month follow-up. At 6-months follow-up, the effects were retained only in the RAS-supported intervention group. For both intervention groups, no improvements were found on secondary outcome measures for gait.
Conclusion(s): Both RAS-supported multimodal balance training and regular multimodal balance training improve balance in PD patients in advanced disease stages. Effects appear to sustain longer in the RAS-supported training group.
Implications: Our findings further support the importance of non-pharmacological intervention in the management of axial problems as gait and balance in PD patients in advanced stages (H&Y4). Current physiotherapy guidelines provide no recommendations on specific approach for the H&Y4 subgroup. The present results, indicating that multimodal balance intervention (combined with rhythmical auditory cues) is effective, can help to fill this gap and contribute to an increasing evidence base for physiotherapy, eventually leading to optimized care for PD patients in advanced stages.
Funding, acknowledgements: Radboudumc Center of Expertise for Parkinson&Movement Disorders was supported by a Center of Excellence grant of the Parkinson’s Foundation
Keywords: Parkinson's disease, Postural instability, Gait disorders
Topic: Neurology: Parkinson's disease
Did this work require ethics approval? Yes
Institution: University of São Paulo
Committee: Comitê de Ética em Pesquisa (CEP)
Ethics number: 3986215
All authors, affiliations and abstracts have been published as submitted.
