Primary studies included in this systematic review

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Shen X, et al

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Primary study

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Effect of virtual reality dance exercise on the balance, activities of daily living, and depressive disorder status of Parkinson's disease patients.

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Authors Lee NY , Lee DK , Song HS
Journal Journal of physical therapy science
Year 2015
Links Pubmed DOI PubMed Central

This article is included in 6 Systematic reviews Systematic reviews (6 references)

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[Purpose] In this study, we examined the effects of virtual reality dance exercise on the balance, activities of daily living and depressive disorder status of Parkinson's disease patients. [Subjects] Twenty patients were assigned either the experimental group (n = 10) or the control group (n = 10). All participants received 30 minutes of neurodevelopment treatment and 15 minutes of functional electrical stimulation 5 times per week for 6 weeks. The experimental group additionally performed 30 minutes of dance exercise. Balance, activities of daily living, and depressive disorder status were assessed before and after the 6-week treatment period using the Berg balance scale, the Modified Barthel Index, and the Beck Depression Inventory. The paired t-test was used to detect differences before and after treatment, and the independent t-test was used to detect differences between the treatment groups. [Results] The values for balance, activities of daily living, and depressive disorder status significantly differed between before and after treatment in the experimental group, and significantly differed between the experimental group and control group. [Conclusion] Virtual reality dance exercise has a positive effect on balance, activities of daily living, and depressive disorder status of Parkinson's disease patients.

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Does integrative medicine enhance balance in aging adults? Proof of concept for the benefit of electroacupuncture therapy in Parkinson's disease

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Journal Gerontology
Year 2015
Links Pubmed DOI PubMed Central www.scopus.com

This article is included in 2 Systematic reviews Systematic reviews (2 references)

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Background: Postural balance and potentially fall risk increases among older adults living with neurological diseases, especially Parkinson's disease (PD). Since conventional therapies such as levodopa or deep brain stimulation may fail to alleviate or may even worsen balance, interest is growing in evaluating alternative PD therapies. Objective: The purpose of the current study was to assess improvement in postural balance in PD patients following electroacupuncture (EA) as an alternative therapy. Methods: 15 aging adults (71.2 ± 6.3 years) with idiopathic PD and 44 healthy age-matched participants (74.6 ± 6.5 years) were recruited. The PD participants were randomly assigned (at a ratio of 2:1) to an intervention (n = 10) or to a control group (n = 5). The intervention group received a 30-min EA treatment on a weekly basis for 3 weeks, while the control group received a sham treatment. Outcomes were assessed at baseline and after the final therapy. Measurements included balance assessment, specifically the ratio of medial-lateral (ML) center-of-gravity (COG) sway to anterior-posterior (AP) sway (COGML/AP) and ankle/hip sway during eyes-open, eyes-closed, and eyes-open dual-task trials, the Unified Parkinson's Disease Rating Scale (UPDRS), as well as quality of life, concerns for fall, and pain questionnaires. Results: No difference was observed for the assessed parameters between the intervention and the control group at baseline. After treatment, an improvement in balance performance was observed in the intervention group. Compared with the healthy population, PD patients prior to treatment had larger COGML/AP sway with more dependency on upper-body movements for maintaining balance. Following EA therapy, COGML/AP sway was reduced by 31% and ankle/hip sway increased by 46% in the different conditions (p = 0.02 for the dual-task condition). The clinical rating revealed an overall improvement (p < 0.01) in mentation, behavior, and mood (UPDRS part I, 49%), activities of daily living (UPDRS part II, 46%), and motor examination (UPDRS part III, 40%). There was a significant reduction (p < 0.02) in the specific items regarding UPDRS fall status (67%) and rigidity (48%). Changes were small and nonsignificant in the controls (p > 0.29). Conclusions: This pilot study demonstrates improvement in rigidity and balance following EA. These preliminary results suggest EA could be a promising alternative treatment for balance disturbance in PD. © 2014 S. Karger AG, Basel.

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Exercise for falls prevention in Parkinson disease: a randomized controlled trial.

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Journal Neurology
Year 2015
Links Pubmed DOI PubMed Central

This article is included in 4 Systematic reviews Systematic reviews (4 references)

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OBJECTIVE: To determine whether falls can be prevented with minimally supervised exercise targeting potentially remediable fall risk factors, i.e., poor balance, reduced leg muscle strength, and freezing of gait, in people with Parkinson disease. METHODS: Two hundred thirty-one people with Parkinson disease were randomized into exercise or usual-care control groups. Exercises were practiced for 40 to 60 minutes, 3 times weekly for 6 months. Primary outcomes were fall rates and proportion of fallers during the intervention period. Secondary outcomes were physical (balance, mobility, freezing of gait, habitual physical activity), psychological (fear of falling, affect), and quality-of-life measures. RESULTS: There was no significant difference between groups in the rate of falls (incidence rate ratio [IRR] = 0.73, 95% confidence interval [CI] 0.45-1.17, p = 0.18) or proportion of fallers (p = 0.45). Preplanned subgroup analysis revealed a significant interaction for disease severity (p < 0.001). In the lower disease severity subgroup, there were fewer falls in the exercise group compared with controls (IRR = 0.31, 95% CI 0.15-0.62, p < 0.001), while in the higher disease severity subgroup, there was a trend toward more falls in the exercise group (IRR = 1.61, 95% CI 0.86-3.03, p = 0.13). Postintervention, the exercise group scored significantly (p < 0.05) better than controls on the Short Physical Performance Battery, sit-to-stand, fear of falling, affect, and quality of life, after adjusting for baseline performance. CONCLUSIONS: An exercise program targeting balance, leg strength, and freezing of gait did not reduce falls but improved physical and psychological health. Falls were reduced in people with milder disease but not in those with more severe Parkinson disease. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that for patients with Parkinson disease, a minimally supervised exercise program does not reduce fall risk. This study lacked the precision to exclude a moderate reduction or modest increase in fall risk from exercise. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ACTRN12608000303347).

Primary study

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Effect of partial weight-supported treadmill gait training on balance in patients with Parkinson disease.

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Journal PM & R : the journal of injury, function, and rehabilitation
Year 2014
Links Pubmed DOI

This article is included in 2 Systematic reviews Systematic reviews (2 references)

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OBJECTIVE: To investigate the role of conventional gait training and partial weight-supported treadmill gait training (PWSTT) in improving the balance of patients with Parkinson disease (PD). DESIGN: Prospective randomized controlled design. SETTING: National-level university tertiary hospital for mental health and neurosciences. PATIENTS: Sixty patients with PD fulfilling the United Kingdom Brain Bank PD diagnostic criteria were recruited from the neurology outpatient department and movement disorder clinic. METHODOLOGY: The patients were randomly assigned into 3 equal groups: (1) a control group that only received a stable dosage of dopaminomimetic drugs; (2) a conventional gait training (CGT) group that received a stable dosage of dopaminomimetic drugs and conventional gait training; and (3) a PWSTT group that received a stable dosage of dopaminomimetic drugs and PWSTT with unloading of 20% of body weight. The sessions for the CGT and PWSTT groups were provided for 30 minutes per day, 4 days per week, for 4 weeks (16 sessions). OUTCOME MEASURES: The Unified Parkinson Disease Rating Scale (UPDRS) motor score, dynamic posturography, Berg Balance Scale, and Tinetti performance-oriented mobility assessment (POMA) were used as main outcome measures. RESULTS: A significant interaction effect was observed in the UPDRS motor score, mediolateral index, Berg Balance Scale, limits of stability (LOS) total score, POMA gait score, and balance score. Post-hoc analysis showed that in comparison with the control group, the PWSTT group had a significantly better UPDRS motor score, balance indices, LOS in 8 directions, POMA gait, and balance score. The CGT group had a significantly better POMA gait score compared with control subjects. Compared with the CGT group, the PWSTT group had a significantly better UPDRS motor score, mediolateral index, POMA gait score, and LOS total score. CONCLUSION: PWSTT may be a better interventional choice than CGT for gait and balance rehabilitation in patients with PD.

Primary study

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Neurofeedback and physical balance in Parkinson's patients.

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Journal Gait & posture
Year 2014
Links Pubmed DOI

This article is included in 2 Systematic reviews Systematic reviews (2 references)

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The primary goal of the present research is to study the effect of a neurofeedback training (NFT) period on balance problems associated with Parkinson's disease. Sixteen patients were selected through purposive sampling and were randomly divided into experimental and control groups. The research procedure included eight sessions. Prior to and after training, pre-tests and post-tests of static and dynamic balance were administered using "limit of stability" for the Biodex as well as the Berg scale. The results revealed that, after neurofeedback training, a statistically significant improvement in both static and dynamic balance in the experimental group was achieved. The means of the Biodex and Berg scores in the experimental group increased from 18.87 to 42.87 and 17.62 to 46.37, respectively. The means of the Biodex and Berg scores in the control group in the pretest were 18.25 and 17.75 and increased to 20.00 and 20.50, respectively. The results suggest that NFT can improve static and dynamic balance in PD patients.

Primary study

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Leg muscle power is enhanced by training in people with Parkinson’s disease: A randomized controlled trial.

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Journal Clinical rehabilitation
Year 2014
Links Pubmed DOI

This article is included in 5 Systematic reviews Systematic reviews (5 references)

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OBJECTIVE: To determine the effects of leg muscle power training in people with Parkinson’s disease. DESIGN: Randomized controlled trial. SETTING: University laboratory (outcome measures and experimental intervention), community (control intervention). Subjects: Community-dwelling people with Parkinson’s disease. INTERVENTIONS: Leg muscle power training using pneumatic variable resistance equipment (experimental) was compared with low intensity sham exercise (control). Both groups exercised twice weekly for 12 weeks. Main measures: Primary outcomes were peak power of four leg muscle groups. Secondary outcomes were measures of muscle strength, mobility, balance and falls. RESULTS: Exercise adherence was high in both groups. Leg muscle power was significantly better in the experimental group than the control group in all four primary outcome measures at 12 weeks after adjusting for baseline values: leg extensors (57.9 watts, 95% confidence interval (CI) 22.0–93.7, <i>p</i> = 0.002); knee flexors (29.6 watts, 95% CI 7.4–51.8, <i>p</i> = 0.01); hip flexors (68.1 watts, 95% CI 19.6–116.5, <i>p</i> = 0.007); and hip abductors (37.4 watts, 95% CI 19.9–54.9, <i>p</i> &lt; 0.001). The experimental group performed significantly better on tests of leg muscle strength (<i>p</i> &lt; 0.001 to 0.07) and showed trends toward better performance in the Timed Up and Go (<i>p</i> = 0.13) and choice stepping reaction time (<i>p</i> = 0.11). There was a non-significant reduction in the rate of falls in the experimental group compared with the control group (incidence rate ratio 0.84, <i>p</i> = 0.76). CONCLUSIONS: This programme significantly improved muscle power in all trained muscle groups. (PsycInfo Database Record (c) 2024 APA, all rights reserved)

Primary study

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Effects of Tai Chi on balance and fall prevention in Parkinson's disease: A randomized controlled trial.

Authors Gao Q , Leung A , Yang Y , Wei Q , Guan M , Jia C , He C
Journal Clinical rehabilitation
Year 2014
Links Pubmed DOI

This article is included in 15 Systematic reviews Systematic reviews (15 references)

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OBJECTIVES: To examine the effects of Tai Chi on balance and functional mobility in people with Parkinson’s disease, and determine whether fall incidence could be reduced by the Tai Chi exercise. DESIGN: Single blinded randomized control trial with 6 months’ follow-up. SETTING: A hospital and general community. Participants: Patients (<i>n</i> = 76) diagnosed with idiopathic Parkinson’s disease, over 40 years old, able to walk independently and fell at least one time during the past 12 months. INTERVENTIONS: The Tai Chi group (<i>n</i> = 37) received 24-form Yang style Tai Chi exercise for 60 minutes each time, three times a week and lasted for 12 weeks. The control group (<i>n</i> = 39) received no intervention. Main outcome measures: Berg Balance Scale (BBS), Unified Parkinson’s Disease Rating Scale (UPDRS) III, Timed Up&amp;Go (TUG) and occurrences of falls. RESULTS: The Tai Chi group improved more than the control group on the BBS (<i>p</i> &lt; 0.05), but there was no difference on UPDRS III scores and Timed Up&amp;Go (<i>p</i> &gt; 0.05). During the 6-month follow-up, only 8 (21.6%) out of 37 patients in the Tai Chi group had experience of falls comparing to 19 (48.7%) out of 39 patients in the control group (<i>p</i> &lt; 0.05). The average times of falls were 0.30 ± 0.62 in the Tai Chi group compared with 0.64 ± 0.74 in the control group (<i>p</i> &lt; 0.05). CONCLUSIONS: Our findings suggested that Tai Chi exercise could improve the balance and decrease the fall risks in patients with Parkinson’s disease. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

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Botulinum toxin type A potentiates the effect of neuromotor rehabilitation of Pisa syndrome in parkinson disease: A placebo controlled study.

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Journal Parkinsonism & related disorders
Year 2014
Links Pubmed DOI

This article is included in 1 Systematic review Systematic reviews (1 reference)

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INTRODUCTION: Pisa syndrome (PS) is a tonic lateral flexion of trunk that represents a disabling complication of advanced Parkinson disease (PD). Conventional rehabilitation treatment (CT) ameliorates axial posture and trunk mobility in PD patients, but the improvement tends to wane in 4–6 months. Botulin toxin (BT) may reduce muscle hyperactivity, therefore improving CT effectiveness. We evaluated whether the injection of incabotulinum toxin type A (iBTA) into the hyperactive trunk muscles might improve the effectiveness of rehabilitation in a group of PD patients with PS. METHODS: Twenty-six PD patients were enrolled in a randomized placebo-controlled trial. Group A was treated with iBTA before undergoing CT (a 4-week intensive programme), while Group B received saline before the 4-week CT treatment. Patients were evaluated at baseline, at the end of the rehabilitative period, 3 and 6 months with kinematic analysis of movement, UPDRS, Functional Independence Measure and Visual Analog Scale for pain. RESULTS: At the end of the rehabilitation period, both groups improved significantly in terms of static postural alignment and of range of motion. Group A showed a significantly more marked reduction in pain score as compared with Group B and a more prolonged efficacy on several clinical and kinematic variables. CONCLUSIONS: Our preliminary data suggest that BT may be considered an important addition to the rehabilitation programme for PD subjects with PS for improving axial posture and trunk mobility, as well as for a better control of pain. (PsycInfo Database Record (c) 2024 APA, all rights reserved)

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Intensive rehabilitation increases BDNF serum levels in Parkinsonian patients: A randomized study.

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Journal Neurorehabilitation and neural repair
Year 2014
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Background. Exercise may decrease the risk of Parkinson’s disease (PD) in humans and reduce PD symptoms in animal models. The beneficial effects have been linked to increased levels of neurotrophic factors. Objective. We examined whether intensive rehabilitation treatment reduces motor disability in patients in the early stages of PD and increases brain-derived neurotrophic factor (BDNF) serum levels. Methods. Thirty participants in the early stages of PD treated with rasagiline were randomly assigned to 3 hours of rehabilitation treatment that included aerobic exercise for 28 days (Group 1) or to not therapy (control; Group 2). BDNF serum levels were assessed at time T0 (baseline, before treatment), T1 (10 days), T2 (20 days), and T3 (28 days). At T0 and T3, we assessed the Unified Parkinson’s Disease Rating Scale (UPDRS) III in both groups, as well as the UPDRS II and total, Berg Balance Scale, and 6-minute walking test only in Group 1. Results. BDNF levels significantly increased at T1 in Group 1, an increase that was maintained throughout the treatment period. At T3 compared to T0, UPDRS III scores significantly improved in Group 1 along with scores for UPDRS II, total, Berg Balance Scale, and 6-minute walking test. Conclusions. Intensive rehabilitation treatment increases the BDNF levels and improves PD signs in patients in the early stages of the disease. These results are in line with studies on animal models of PD and healthy subjects. (PsycInfo Database Record (c) 2024 APA, all rights reserved)