EFFICACY OF A MULTIMODAL PHYSIOTHERAPY INTERVENTION TO TARGET BALANCE CAPACITY IN HUNTINGTON’S DISEASE: A DOUBLE-BLIND, RANDOMIZED CLINICAL TRIAL

T. Capato^1,2, J. Nonnekes³, J. Tornai¹, J. Ramjith⁴, J. IntHout⁴, E. Barbosa¹, B. Bloem²

¹University of São Paulo, Neurology, São Paulo, Brazil, ²Radboudumc, Neurology, Nijmegen, Netherlands, ³Radboudumc, Rehabilitation, Nijmegen, Netherlands, ⁴Radboudumc, Health Evidence, Nijmegen, Netherlands

Background: Huntington´s Disease (HD) is an autosomal dominant neurodegenerative disease characterized by progressive chorea, behavioral, and cognitive impairments. According to the disease progression, balance impairments in HD are common and lead to disability and functional independence loss. Current physiotherapy guidelines provide no recommendations on a specific approach to improve balance in HD. So far, no study specifically focused on physiotherapy to improve balance capacity in people with HD.

Purpose: We had three aims:
1) to investigate the effects of multimodal physiotherapy on balance capacity in HD;
2) to evaluate whether multimodal balance intervention can be optimized by adding rhythmical auditory stimuli to the intervention;
(3) to identify whether these effects would be maintained in the long period.

Methods: A prospective, double-blind, randomized clinical trial was performed. We screened 56 people with HD; 34 patients with genetically confirmed HD were assigned randomly into three groups:
(1) multimodal balance intervention supported by rhythmical auditory stimuli (RAS-supported n=12);
(2) multimodal standard balance intervention without rhythmical auditory stimuli (Regular n=12); and
(3) control intervention (consisting of an educational program, n=10).
Interventions were delivered for five weeks, 1 session/week. The primary outcome was the Mini-Best test (MBEST) scored directly after the intervention. A blinded assessor assessed patients at 3 time points (baseline, directly post-intervention, and after 6-months follow-up). The University of São Paulo Faculty Medicine Clinics Hospital received ethical approval for the study (CEP - 4.282.414) registered at ReBEC Trials Registry (U1111-1280-8136).

Results: The groups were similar on baseline characteristics. Directly post-intervention, both the RAS-supported and Regular intervention groups improved significantly on MBEST test score compared to patients receiving the control intervention (RAS-supported 4.2 (95% Confidence Interval (CI) 3.1; 5.2)), p<0.001; Regular 1.9 (CI 1.7; 3.6), p<0.001), whereas the control group did not change. The improvements in the intervention groups were not retained at 6-months follow-up. Both intervention groups improved their gait speed and mobility with and without RAS. No adverse events related to the intervention happened during the study period.

Conclusions: Multimodalphysiotherapyintervention improves balance capacity in HD. Future large studies may further explore these findings.

Implications: Our findings further support the importance of multimodal physiotherapy intervention in managing balance in HD patients in early and mild stages. These findings suggest several courses of action for contribution to an increasing evidence base for physiotherapy in HD, as indicate that RAS-supported multimodal balance intervention (i.e., combined with rhythmical auditory cues) is a promising intervention and can help to fill this gap.

Funding acknowledgements: We would like to thank the University of São Paulo for supporting this study, Associação Brasil Huntington and the participants.

Keywords:
Huntington's disease
Balance training
Gait training

Topics:
Neurology
Neurology: Parkinson's disease
Disability & rehabilitation

Did this work require ethics approval? Yes

Institution: University of São Paulo

Committee: Comissāo de Ética para Análise de Projetos de Pesquisa

Ethics number: CEP - 4.282.414