Combined Reactive and Volitional Step Training Improves Balance Recovery and Stepping Reaction Time in People With Parkinson's Disease: A Randomised Controlled Trial.
Paulo H S Pelicioni, Stephen R Lord, Jasmine C Menant and 5 others
PMID 37864439WHAT IT FOUND
People with Parkinson’s disease who did 12 weeks of home stepping games plus two supervised slip/trip sessions had faster choice stepping reaction times and fewer total laboratory falls than controls, but daily-life falls were not reduced.
Key findings
01The intervention group had significantly faster choice stepping reaction time total times than the control group at reassessment (P = .004).
02The intervention group experienced significantly fewer total laboratory-induced falls than the control group (incidence rate ratio 0.51, 95% CI 0.30-0.89, P = .017).
03Daily-life fall rates did not differ significantly between groups (incidence rate ratio 0.86, 95% CI 0.23-3.32, P = .59).
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only 44 participants were randomized, and 9 were not assessed for reactive balance because of health concerns, so the laboratory fall results may reflect healthier participants. The intervention combined home exergames and supervised reactive training, so the contribution of each part cannot be separated. Control participants had less contact than intervention participants, which may have influenced outcomes. The trial was powered for laboratory falls, not daily-life falls; the daily-life fall estimate had too wide a range to draw a conclusion. Reactive training was only 2 sessions, which may be too low a dose for some people.
Declared interests
The authors declared no potential conflicts of interest. The study was supported by a Parkinson’s NSW seed grant. One author received a Coordenação de Aperfiçoamento de Pessoal de Nivel Superior PhD scholarship, and another was supported by an NHMRC Investigator Grant.
The easy way to misread this
Do not conclude that this program reduces falls in daily life. The laboratory outcomes improved, but the daily-life fall rate difference was not significant (incidence rate ratio 0.86, 95% CI 0.23-3.32, P = .59).