Predictors of Gait Improvement in Patients With Parkinson's Disease After Rehabilitation

NCT ID: NCT03336307

Last Updated: 2017-11-08

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

36 participants

Study Classification

OBSERVATIONAL

Study Start Date

2014-05-31

Study Completion Date

2017-07-31

Brief Summary

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Patients with Parkinson's disease show a gait disturbance which is considered as one of the most disabling aspect of the disease that strongly impacts on patients' autonomy and quality of life. The mechanism underlying gait impairment is multi-factorial, reflects the global motor impairment of patients with PD and is mainly related to a neurotransmitter deficiency inducing bradykinesia, rigidity, abnormal trunk control and postural instability. For this reason, and considering the impact of social and economic costs, one of the main foci of intervention in patients with PD should be treating gait abnormalities. This need is further reinforced by the knowledge that gait outcomes are correlated with longevity, cognitive decline and adverse events.

Besides the shorten-step gait clinical description of the gait disorder in PD, in the last years, studies using modern 3D motion analysis systems have further detailed the gait pattern in PD disclosing abnormalities in cadence, stance duration, swing duration, double support duration, leg length, step length, velocity, hip, knee and ankle ROMs. Such abnormal gait parameters seem to correlate with the clinical outcomes of UPDRS score, H-Y stage and milliequivalents of levodopa taken. Importantly, gait parameters can either normalize or improve after several rehabilitative treatment strategies including physiotherapy, assistive equipment, sensory cueing, treadmill training, physical activity, home base exercises. However, none of the previous studies specifically investigated which biomechanical factor can be modified after rehabilitation and which clinical characteristic can predict the rehabilitation-induced gait improvement. This would be extremely important to typifying, grouping and selecting patients, optimizing the rehabilitative strategies and cost management.

The aims of the present study were to evaluate in a sample of patients with PD: i) which gait parameters can be modified after a short-term rehabilitation program; ii) which, if any, clinical variable can predict the improvement of the gait function after rehabilitation. At this aim we quantitatively evaluated the gait performance of PD patients by means of a 3-D motion analysis system.

Detailed Description

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Fifty out of 67 patients with idiopathic PD assessed for eligibility were recruited at Rehabilitation Unit of Department of Medical and Surgical Sciences and Biotechnologies, University of Rome, Sapienza, and at Rehabilitation Unit of Policlinico Italia Centre, Rome, Italy. Patients were admitted for outpatient rehabilitation between May 2014 and April 2017. The inclusion criteria were a diagnosis of idiopathic PD according to UK bank criteria and Hoehn and Yahr stages 1 to 3. All patients were in a stable drug program and had adapted to their current medications for at least 2 weeks. Exclusion criteria were: cognitive deficits (defined as scores of \<26 on the Mini-Mental State Examination \[MMSE\]), moderate or severe depression (defined as scores of \>17 on the Beck Depression Inventory \[BDI\]), and orthopedic and other gait-influencing diseases such as arthrosis or total hip joint replacement.

All participants could walk independently without walking devices. All patients were taking oral administrations of levodopa (18 patients), dopamine agonists (5 patients), or both (13 patients) and were recorded in on phase.

Severity of parkinsonism was evaluated using the Unified Parkinson's Disease Rating Scale (UPDRS-II and III) and the Hoehn and Yahr staging system.

The study complied with the Helsinki Declaration and received local ethics committee approval. Prior to taking part in the study, all the participants gave a written consent after a fully explanation of the experimental procedure.

Conditions

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Parkinson Disease Movement Disorders

Keywords

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Parkinson disease movement Disorders gait disturbance Parkinson Parkinson gait 3D motion analysis systems motion analysis Parkinson rehabilitation rehabilitation gait improvement gait improvement SMART Capture MATLAB software

Study Design

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Observational Model Type

CASE_CONTROL

Study Time Perspective

PROSPECTIVE

Study Groups

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Patients with Parkinson's disease

All participants could walk independently without walking devices. All patients were taking oral administrations of levodopa (18 patients), dopamine agonists (5 patients), or both (13 patients) and were recorded in on phase. Medication was kept constant throughout the trial, and all interventions were performed at the same time of day for each patient during ON phase.

Severity of parkinsonism was evaluated using the Unified Parkinson's Disease Rating Scale (UPDRS-II and III) and the Hoehn and Yahr staging system.

All patients received a rehabilitation program planned according to the European Physiotherapy guideline for Parkinson's disease

Rehabilitation program

Intervention Type OTHER

all patients received a rehabilitation program planned according to the European Physiotherapy guideline for Parkinson's disease and focus on:

* endurance, strength, flexibility and balance with functional practice for all H/Y stage
* endurance also for H/Y stage 1,
* motor learning principles and cue functional for H/Y stage 2-3
* external cues and self-instruction strategies and attention H/Y for stage 2-3 The rehabilitative program comprised 60-minute sessions a day (3d/wk).

Interventions

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Rehabilitation program

all patients received a rehabilitation program planned according to the European Physiotherapy guideline for Parkinson's disease and focus on:

* endurance, strength, flexibility and balance with functional practice for all H/Y stage
* endurance also for H/Y stage 1,
* motor learning principles and cue functional for H/Y stage 2-3
* external cues and self-instruction strategies and attention H/Y for stage 2-3 The rehabilitative program comprised 60-minute sessions a day (3d/wk).

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Diagnosis of idiopathic PD according to UK bank criteria
* Hoehn and Yahr stages 1 to 3.
* All patients were in a stable drug program and had adapted to their current medications for at least 2 weeks

Exclusion Criteria

* Cognitive deficits (defined as scores of \<26 on the Mini-Mental State Examination \[MMSE\]),
* moderate or severe depression (defined as scores of \>17 on the Beck Depression Inventory \[BDI\]), -. orthopedic and other gait-influencing diseases such as arthrosis or total hip joint replacement.
Minimum Eligible Age

48 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Roma La Sapienza

OTHER

Sponsor Role lead

Responsible Party

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Mariano Serrao

Clinical Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Guido Caramanico, MD

Role: PRINCIPAL_INVESTIGATOR

Università "La Sapienza di Roma"

Locations

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Policlinico Italia Srl

Rome, Lazio, Italy

Site Status

Countries

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Italy

References

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Meunier S, Pol S, Houeto JL, Vidailhet M. Abnormal reciprocal inhibition between antagonist muscles in Parkinson's disease. Brain. 2000 May;123 ( Pt 5):1017-26. doi: 10.1093/brain/123.5.1017.

Reference Type BACKGROUND
PMID: 10775546 (View on PubMed)

Pistacchi M, Gioulis M, Sanson F, De Giovannini E, Filippi G, Rossetto F, Zambito Marsala S. Gait analysis and clinical correlations in early Parkinson's disease. Funct Neurol. 2017 Jan/Mar;32(1):28-34. doi: 10.11138/fneur/2017.32.1.028.

Reference Type BACKGROUND
PMID: 28380321 (View on PubMed)

Vieregge P, Stolze H, Klein C, Heberlein I. Gait quantitation in Parkinson's disease--locomotor disability and correlation to clinical rating scales. J Neural Transm (Vienna). 1997;104(2-3):237-48. doi: 10.1007/BF01273184.

Reference Type BACKGROUND
PMID: 9203085 (View on PubMed)

Pau M, Corona F, Pili R, Casula C, Sors F, Agostini T, Cossu G, Guicciardi M, Murgia M. Effects of Physical Rehabilitation Integrated with Rhythmic Auditory Stimulation on Spatio-Temporal and Kinematic Parameters of Gait in Parkinson's Disease. Front Neurol. 2016 Aug 11;7:126. doi: 10.3389/fneur.2016.00126. eCollection 2016.

Reference Type BACKGROUND
PMID: 27563296 (View on PubMed)

Keus SH, Munneke M, Nijkrake MJ, Kwakkel G, Bloem BR. Physical therapy in Parkinson's disease: evolution and future challenges. Mov Disord. 2009 Jan 15;24(1):1-14. doi: 10.1002/mds.22141.

Reference Type BACKGROUND
PMID: 18946880 (View on PubMed)

Other Identifiers

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s001

Identifier Type: -

Identifier Source: org_study_id