帕金森病易跌倒患者在进行反应步训练后的稳定性变化

IF 2.6 3区 医学 Q2 CLINICAL NEUROLOGY
Journal of Neurologic Physical Therapy Pub Date : 2024-01-01 Epub Date: 2023-06-01 DOI:10.1097/NPT.0000000000000442
Andrew S Monaghan, Andrew Hooyman, Leland E Dibble, Shyamal H Mehta, Daniel S Peterson
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引用次数: 0

摘要

背景和目的:反应性步态不佳可能会导致帕金森病患者(PwPD)跌倒。然而,能否改善有跌倒风险的帕金森病患者的反应性台阶,或者台阶训练能否减少跌倒,目前仍不清楚。本研究旨在确定为期两周的反应性台阶训练是否会(1)立即并持续改善帕金森病患者的台阶能力,以及(2)减少有跌倒风险的帕金森病患者的预期跌倒:25 名有跌倒风险的残疾人(70.52 岁 ± 7.15;Hoehn & Yahr 范围 1-3)完成了一项多基线、开放标签、非对照的干预前/后研究。在 2 次基线评估(B1 和 B2)后进行为期 2 周、共 6 个疗程的训练方案,对步态表现进行评估。分别在训练开始后(P1)和训练结束后 2 个月(P2)对步态进行评估。主要结果是前后稳定幅度(MOS)、步长和后退时的步长潜伏期。跌倒频率在训练前后两个月进行测量:结果:训练后,向后迈步时的 MOS 明显增大(更好)(P < 0.001,d = 0.83),改善效果保持了 2 个月(P = 0.04,d = 0.66)。步长在训练后(P = 0.13,d = 0.46)或随访时(P = 0.08,d = 0.62)没有显著统计学差异,但效应大小分别为中等和较大。初次接触后,步态潜伏期有所改善(P = 0.01,d = 0.60),但训练后没有改善(P = 0.43,d = 0.35)。与训练前相比,12 名参与者在训练后摔倒的次数减少了(10 = 无变化,5 = 增加;P = 0.12)。MOS的提高与跌倒次数的减少有关(P = 0.04):两周的反应性台阶训练使有跌倒风险的残疾人的某些反应性台阶结果得到了即时和持续的改善,并可降低跌倒风险。反应性台阶训练可能是减少残疾人跌倒的一种可行方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Stability Changes in Fall-Prone Individuals With Parkinson Disease Following Reactive Step Training.

Background and purpose: Poor reactive steps may lead to falls in people with Parkinson disease (PwPD). However, whether reactive steps can be improved in PwPD at risk for falls or whether step training reduces falls remains unclear. This study aimed to determine whether 2 weeks of reactive step training result in (1) immediate and retained improvements in stepping and (2) fewer prospective falls in PwPD at fall risk.

Methods: Twenty-five PwPD (70.52 years ± 7.15; Hoehn & Yahr range 1-3) at risk for falls completed a multiple baseline, open-label, uncontrolled pre-/postintervention study. Stepping performance was assessed at 2 baseline assessments (B1 and B2) followed by a 2-week, 6-session training protocol. Stepping was assessed immediately (P1) and 2 months after training (P2). Primary outcomes were anterior-posterior margin of stability (MOS), step length, and step latency during backward stepping. Fall frequency was measured for 2 months before and after training.

Results: MOS during backward steps was significantly larger (better) after training ( P < 0.001, d = 0.83), and improvements were retained for 2 months ( P = 0.04, d = 0.66). Step length was not statistically significant different after training ( P = 0.13, d = 0.46) or at follow-up ( P = 0.08, d = 0.62), although effect sizes were medium and large, respectively. Step latency improved after initial exposure ( P = 0.01, d = 0.60) but not following training ( P = 0.43, d = 0.35). Twelve participants experienced fewer falls after training than before (10 = no change, 5 = increase; P = 0.12). Greater improvements in MOS were related to fewer falls ( P = 0.04).

Discussion and conclusions: Two weeks of reactive step training resulted in immediate and retained improvements in some reactive stepping outcomes in PwPD at risk for falls and may reduce fall risk. Reactive step training may be a viable approach to reduce falls in PwPD.

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来源期刊
Journal of Neurologic Physical Therapy
Journal of Neurologic Physical Therapy CLINICAL NEUROLOGY-REHABILITATION
CiteScore
5.70
自引率
2.60%
发文量
63
审稿时长
>12 weeks
期刊介绍: The Journal of Neurologic Physical Therapy (JNPT) is an indexed resource for dissemination of research-based evidence related to neurologic physical therapy intervention. High standards of quality are maintained through a rigorous, double-blinded, peer-review process and adherence to standards recommended by the International Committee of Medical Journal Editors. With an international editorial board made up of preeminent researchers and clinicians, JNPT publishes articles of global relevance for examination, evaluation, prognosis, intervention, and outcomes for individuals with movement deficits due to neurologic conditions. Through systematic reviews, research articles, case studies, and clinical perspectives, JNPT promotes the integration of evidence into theory, education, research, and practice of neurologic physical therapy, spanning the continuum from pathophysiology to societal participation.
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