OBJECTIVES: Gait and mobility problems are difficult to treat in people with Parkinson's disease. The Rehabilitation in Parkinson's Disease: Strategies for Cueing (RESCUE) trial investigated the effects of a home physiotherapy programme based on rhythmical cueing on gait and gait-related activity. METHODS: A single-blind randomised crossover trial was set up, including 153 patients with Parkinson's disease aged between 41 and 80 years and in Hoehn and Yahr stage II-IV. Subjects allocated to early intervention (n = 76) received a 3-week home cueing programme using a prototype cueing device, followed by 3 weeks without training. Patients allocated to late intervention (n = 77) underwent the same intervention and control period in reverse order. After the initial 6 weeks, both groups had a 6-week follow-up without training. Posture and gait scores (PG scores) measured at 3, 6 and 12 weeks by blinded testers were the primary outcome measure. Secondary outcomes included specific measures on gait, freezing and balance, functional activities, quality of life and carer strain. RESULTS: Small but significant improvements were found after intervention of 4.2% on the PG scores (p = 0.005). Severity of freezing was reduced by 5.5% in freezers only (p = 0.007). Gait speed (p = 0.005), step length (p<0.001) and timed balance tests (p = 0.003) improved in the full cohort. Other than a greater confidence to carry out functional activities (Falls Efficacy Scale, p = 0.04), no carry-over effects were observed in functional and quality of life domains. Effects of intervention had reduced considerably at 6-week follow-up. CONCLUSIONS:Cueing training in the home has specific effects on gait, freezing and balance. The decline in effectiveness of intervention effects underscores the need for permanent cueing devices and follow-up treatment. Cueing training may be a useful therapeutic adjunct to the overall management of gait disturbance in Parkinson's disease.
RCT Entities:
OBJECTIVES: Gait and mobility problems are difficult to treat in people with Parkinson's disease. The Rehabilitation in Parkinson's Disease: Strategies for Cueing (RESCUE) trial investigated the effects of a home physiotherapy programme based on rhythmical cueing on gait and gait-related activity. METHODS: A single-blind randomised crossover trial was set up, including 153 patients with Parkinson's disease aged between 41 and 80 years and in Hoehn and Yahr stage II-IV. Subjects allocated to early intervention (n = 76) received a 3-week home cueing programme using a prototype cueing device, followed by 3 weeks without training. Patients allocated to late intervention (n = 77) underwent the same intervention and control period in reverse order. After the initial 6 weeks, both groups had a 6-week follow-up without training. Posture and gait scores (PG scores) measured at 3, 6 and 12 weeks by blinded testers were the primary outcome measure. Secondary outcomes included specific measures on gait, freezing and balance, functional activities, quality of life and carer strain. RESULTS: Small but significant improvements were found after intervention of 4.2% on the PG scores (p = 0.005). Severity of freezing was reduced by 5.5% in freezers only (p = 0.007). Gait speed (p = 0.005), step length (p<0.001) and timed balance tests (p = 0.003) improved in the full cohort. Other than a greater confidence to carry out functional activities (Falls Efficacy Scale, p = 0.04), no carry-over effects were observed in functional and quality of life domains. Effects of intervention had reduced considerably at 6-week follow-up. CONCLUSIONS: Cueing training in the home has specific effects on gait, freezing and balance. The decline in effectiveness of intervention effects underscores the need for permanent cueing devices and follow-up treatment. Cueing training may be a useful therapeutic adjunct to the overall management of gait disturbance in Parkinson's disease.
Authors: R P S Van Peppen; G Kwakkel; S Wood-Dauphinee; H J M Hendriks; Ph J Van der Wees; J Dekker Journal: Clin Rehabil Date: 2004-12 Impact factor: 3.477
Authors: I Lim; E van Wegen; C de Goede; M Deutekom; A Nieuwboer; A Willems; D Jones; L Rochester; G Kwakkel Journal: Clin Rehabil Date: 2005-10 Impact factor: 3.477
Authors: Lynn Rochester; Victoria Hetherington; Diana Jones; Alice Nieuwboer; Anne-Marie Willems; Gert Kwakkel; Erwin Van Wegen Journal: Arch Phys Med Rehabil Date: 2005-05 Impact factor: 3.966
Authors: Arlène D Speelman; Bart P van de Warrenburg; Marlies van Nimwegen; Giselle M Petzinger; Marten Munneke; Bastiaan R Bloem Journal: Nat Rev Neurol Date: 2011-07-12 Impact factor: 42.937
Authors: L Rochester; A Nieuwboer; K Baker; V Hetherington; A-M Willems; F Chavret; G Kwakkel; E Van Wegen; I Lim; D Jones Journal: J Neural Transm (Vienna) Date: 2007-06-28 Impact factor: 3.575
Authors: Elke Heremans; A Nieuwboer; J Spildooren; J Vandenbossche; N Deroost; E Soetens; E Kerckhofs; S Vercruysse Journal: J Neural Transm (Vienna) Date: 2013-01-18 Impact factor: 3.575