Randomized cross-over trial to investigate the efficacy of a two-week physiotherapy programme with repetitive exercises of cueing to reduce the severity of freezing of gait in patients with Parkinson’s disease

• Published in: Clinical rehabilitation Vol. 28; no. 9; pp. 902 - 911
• Main Authors: Fietzek, Urban M, Schroeteler, Frauke E, Ziegler, Kerstin, Zwosta, Jens, Ceballos-Baumann, Andres O
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.09.2014; Sage Publications Ltd
• Subjects: Acoustics; Aged; Clinical trials; Cross-Over Studies; Cues; Exercise Therapy - methods; Female; Gait; Gait Disorders, Neurologic - etiology; Gait Disorders, Neurologic - rehabilitation; Germany; Humans; Intervention; Levodopa - therapeutic use; Male; Middle Aged; Outcome Assessment (Health Care); Outpatients; Parkinson Disease - complications; Parkinson Disease - drug therapy; Parkinson Disease - rehabilitation; Parkinson's disease; Patients; Physical therapy; Questionnaires; Severity of Illness Index; Germany; Randomized cross-over trial; freezing; gait; physiotherapy; Parkinson’s disease
• ISSN: 0269-2155; 1477-0873
• DOI: 10.1177/0269215514527299

Objective: To investigate the efficacy of a two-week programme of repetitive exercise with cueing and movement strategies upon freezing of gait in people with Parkinson’s disease. Design: Randomized cross-over trial. Setting: Specialist clinic for Parkinson’s disease. Subjects: A total of 22 patients with Parkinson’s disease and freezing while other symptoms had favorably responded to dopaminergic treatment. Intervention: Patients were randomized into a four-week cross-over trial, and received either treatment (Group 1) or no treatment (Group 2) during Period 1, and switched during Period 2. Treatment consisted of a two-week programme during which the patients exercised cueing, and movement strategies together with a physiotherapist. Main measure: The primary outcome measure was a freezing score assessed from blinded and random ratings of video recordings. The secondary outcome measure was a patient-reported freezing questionnaire. Mean differences between the treatment periods (treatment arms) were evaluated for treatment (period) effects. Sums of treatment periods were evaluated for carry-over effects. Results: The programme led to a significant treatment effect in the freezing score of 3.0 improvement (95% confidence interval 0.9–5.0; p < 0.01). No carry-over or period effects were detected. The questionnaire revealed a period effect, so groups were compared after Period 1, where a significant difference was found (15.0 vs. 11.7; p < 0.05). Conclusions: The two-week physiotherapy programme reduced the severity of freezing in patients with Parkinson’s disease.