Suhaila M Santos1, Rubens A da Silva2, Marcelle B Terra3,2, Isabela A Almeida3,2, Lúcio B de Melo4, Henrique B Ferraz5. 1. Department of Physiotherapy, Londrina State University, Londrina, Brazil - suhailaneuro@gmail.com. 2. Norte do Paraná University, Londrina, Brazil. 3. Department of Physiotherapy, Londrina State University, Londrina, Brazil. 4. Department of Neurology, Londrina State University, Londrina, Brazil. 5. Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo, Brazil.
Abstract
BACKGROUND: Evidences have shown that physiotherapy programs may improve the balance of individuals with Parkinson's disease (PD), although it is not clear which specific exercise program is better. AIM: The aim of this study was to compare the effectiveness of balance versus resistance training on postural control measures in PD patients. DESIGN: Randomized controlled trial. SETTING: The study was conducted in a physiotherapy outpatient clinic of a university hospital. POPULATION: A total of 40 PD participants were randomly divided into two groups: balance training (BT) and resistance training (RT). METHODS: The BT group focused on balance training, functional independence and gait while the RT group performed resistance exercises emphasizing the lower limbs and trunk, both supervised by trained physiotherapists. Therapy sessions were held twice a week (at 60 minutes), totaling 24 sessions. The primary outcome was evaluated by force platform with center of pressure sway measures in different balance conditions and the secondary outcome was evaluated by Balance Evaluation Systems Test (BESTest) scale to determine the effects of the intervention on postural control. RESULTS: Significant improvement of postural control (pre vs. post 15.1 vs. 9.6 cm2) was only reported in favor of BT group (d=1.17) for one-legged stand condition on force platform. The standardized mean difference between groups was significantly (P<0.02), with 36% of improvement for BT vs. 0.07% for RT on this condition. Significant improvement (P<0.05) was also observed in favor of BT (in mean 3.2%) for balance gains in some BESTest scores, when compared to RT group (-0.98%). CONCLUSIONS:Postural control in Parkinson's disease is improved when training by a directional and specific balance program than a resistance training program. CLINICAL REHABILITATION IMPACT: Balance training is superior to resistance training in regard to improving postural control of individuals with PD. Gold standard instruments (high in cost and difficult to access) were used to assess balance, as well as scales with clinical applicability (low cost, easily acceptable, applicable and valid), which can guide the management of physiotherapists both in their decision-making and in clinical practice.
RCT Entities:
BACKGROUND: Evidences have shown that physiotherapy programs may improve the balance of individuals with Parkinson's disease (PD), although it is not clear which specific exercise program is better. AIM: The aim of this study was to compare the effectiveness of balance versus resistance training on postural control measures in PDpatients. DESIGN: Randomized controlled trial. SETTING: The study was conducted in a physiotherapy outpatient clinic of a university hospital. POPULATION: A total of 40 PDparticipants were randomly divided into two groups: balance training (BT) and resistance training (RT). METHODS: The BT group focused on balance training, functional independence and gait while the RT group performed resistance exercises emphasizing the lower limbs and trunk, both supervised by trained physiotherapists. Therapy sessions were held twice a week (at 60 minutes), totaling 24 sessions. The primary outcome was evaluated by force platform with center of pressure sway measures in different balance conditions and the secondary outcome was evaluated by Balance Evaluation Systems Test (BESTest) scale to determine the effects of the intervention on postural control. RESULTS: Significant improvement of postural control (pre vs. post 15.1 vs. 9.6 cm2) was only reported in favor of BT group (d=1.17) for one-legged stand condition on force platform. The standardized mean difference between groups was significantly (P<0.02), with 36% of improvement for BT vs. 0.07% for RT on this condition. Significant improvement (P<0.05) was also observed in favor of BT (in mean 3.2%) for balance gains in some BESTest scores, when compared to RT group (-0.98%). CONCLUSIONS: Postural control in Parkinson's disease is improved when training by a directional and specific balance program than a resistance training program. CLINICAL REHABILITATION IMPACT: Balance training is superior to resistance training in regard to improving postural control of individuals with PD. Gold standard instruments (high in cost and difficult to access) were used to assess balance, as well as scales with clinical applicability (low cost, easily acceptable, applicable and valid), which can guide the management of physiotherapists both in their decision-making and in clinical practice.
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