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Sarasso E, Parente MP, Agosta F, Filippi M, Corbetta D. Dual-Task vs. Single-Task Gait Training to Improve Spatiotemporal Gait Parameters in People with Parkinson's Disease: A Systematic Review and Meta-Analysis. Brain Sci 2024; 14:517. [PMID: 38790495 PMCID: PMC11119953 DOI: 10.3390/brainsci14050517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND People with Parkinson's disease (pwPD) present alterations of spatiotemporal gait parameters that impact walking ability. While preliminary studies suggested that dual-task gait training improves spatiotemporal gait parameters, it remains unclear whether dual-task gait training specifically improves dual-task gait performance compared to single-task gait training. The aim of this review is to assess the effect of dual-task training relative to single-task gait training on specific gait parameters during dual-task tests in pwPD. METHODS We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs), searching three electronic databases. Two reviewers independently selected RCTs, extracted data, and applied the Cochrane risk-of-bias tool for randomized trials (Version 2) and the GRADE framework for assessing the certainty of evidence. The primary outcomes were dual-task gait speed, stride length, and cadence. Secondary outcomes included dual-task costs on gait speed, balance confidence, and quality of life. RESULTS We included 14 RCTs (548 patients). Meta-analyses showed effects favoring dual-task training over single-task training in improving dual-task gait speed (standardized mean difference [SMD] = 0.48, 95% confidence interval [CI] = 0.20-0.77; 11 studies; low certainty evidence), stride length (mean difference [MD] = 0.09 m, 95% CI = 0.04-0.14; 4 studies; very low certainty evidence), and cadence (MD = 5.45 steps/min, 95% CI = 3.59-7.31; 5 studies; very low certainty evidence). We also found a significant effect of dual-task training over single-task training on dual-task cost and quality of life, but not on balance confidence. CONCLUSIONS Our findings support the use of dual-task training relative to single-task training to improve dual-task spatiotemporal gait parameters in pwPD. Further studies are encouraged to better define the features of dual-task training and the clinical characteristics of pwPD to identify better responders.
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Affiliation(s)
- Elisabetta Sarasso
- Vita-Salute San Raffaele University, 20132 Milan, Italy; (E.S.); (M.P.P.); (F.A.); (M.F.)
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, 16132 Genoa, Italy
| | - Marco Pietro Parente
- Vita-Salute San Raffaele University, 20132 Milan, Italy; (E.S.); (M.P.P.); (F.A.); (M.F.)
| | - Federica Agosta
- Vita-Salute San Raffaele University, 20132 Milan, Italy; (E.S.); (M.P.P.); (F.A.); (M.F.)
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Massimo Filippi
- Vita-Salute San Raffaele University, 20132 Milan, Italy; (E.S.); (M.P.P.); (F.A.); (M.F.)
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Davide Corbetta
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
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Haputhanthirige NKH, Sullivan K, Moyle G, Brauer S, Jeffrey ER, Kerr G. Effects of dance on gait and dual-task gait in Parkinson's disease. PLoS One 2023; 18:e0280635. [PMID: 36693038 PMCID: PMC9873168 DOI: 10.1371/journal.pone.0280635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 11/09/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Gait impairments in Parkinson's disease (PD) limit independence and quality of life. While dance-based interventions could improve gait, further studies are needed to determine if the benefits generalise to different terrains and when dual-tasking. The aim was to assess the effects of a dance intervention, based on the Dance for PD® (DfPD®) program, on gait under different dual-tasks (verbal fluency, serial subtraction) and surfaces (even, uneven), and to determine if a larger scale follow-up RCT is warranted. METHODS A dance group (DG; n = 17; age = 65.8 ± 11.7 years) and a control group (CG: n = 16; age = 67.0 ± 7.7 years) comprised of non-cognitively impaired (Addenbrooke's score: DG = 93.2 ± 3.6, CG = 92.6 ± 4.3) independently locomoting people with PD (Hoehn & Yahr I-III). The DG undertook a one-hour DfPD®-based class, twice weekly for 12 weeks. The CG had treatment as usual. The spatiotemporal variables of gait were assessed at baseline and post-intervention while walking on two surfaces (even, uneven) under three conditions: regular walking; dual-task: verbal-fluency (DTVERB), and serial-subtraction (DTSUBT). The data were analysed by means of a linear mixed model. RESULTS At baseline, there was no significant group difference for any spatiotemporal gait variable. The DG improved significantly compared to the CG with and without a dual task when walking on even surface. During regular walking, DG improved in gait velocity (p = 0.017), cadence (p = 0.039), step length (p = 0.040) and stride length (p = 0.041). During DTVERB significant improvements were noted in gait velocity (p = 0.035), cadence (p = 0.034) and step length (p = 0.039). The DG also exhibited significant improvement compared to the CG during DTSUBT in the measures of gait velocity (p = 0.012), cadence (p = 0.021), step length (p = 0.018), and stride length (p = 0.151). On the uneven surface, improvements were noted when walking while performing serial subtractions only. During regular walking, improvements were noted for the CG but not for the DG. CG has spent less time in double support following the intervention than DG. While DTVERB condition had no significant group differences for any gait parameter (p's >0.05), in the DTSUBT condition, the DG improved significantly compared to the controls on gait velocity (p = 0.048), cadence (p = 0.026), and step length (p = 0.051). CONCLUSIONS DfPD®-based classes produced clinically significant improvement in spatiotemporal gait parameters under dual-task conditions and on uneven surfaces. This could arise from improved movement confidence and coordination; emotional expression; cognitive skills (planning, multitasking), and; utilisation of external movement cues. A large-scale RCT of this program is warranted. TRIAL REGISTRATION A protocol for this study has been registered retrospectively at the Australian New Zealand Clinical Trials Registry. Identifier: ACTRN12618001834246.
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Affiliation(s)
- Nadeesha Kalyani Hewa Haputhanthirige
- Movement Neuroscience Group, Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Queensland, Australia
- Faculty of Health, School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Faculty of Medicine, Department of Allied Health Sciences, University of Colombo, Sri Lanka
| | - Karen Sullivan
- Faculty of Health, School of Psychology and Counselling, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Gene Moyle
- Faculty of Creative Industries, School of Creative Practice, Queensland University of Technology, Brisbane, Queensland, Australia
- Academic Division, Office of the Deputy Vice-Chancellor (Academic), Queensland University of Technology, Brisbane, Queensland, Australia
| | - Sandy Brauer
- Faculty of Health and Behavioural Sciences, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Erica Rose Jeffrey
- Queensland Ballet, South Brisbane, Queensland, Australia
- Dance for Parkinson’s Australia, Brisbane, Queensland, Australia
| | - Graham Kerr
- Movement Neuroscience Group, Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Queensland, Australia
- Faculty of Health, School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
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Dissanayaka NN, Forbes EJ, Perepezko K, Leentjens AFG, Dobkin RD, Dujardin K, Pontone GM. Phenomenology of Atypical Anxiety Disorders in Parkinson's Disease: A Systematic Review. Am J Geriatr Psychiatry 2022; 30:1026-1050. [PMID: 35305884 DOI: 10.1016/j.jagp.2022.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 02/03/2022] [Accepted: 02/10/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Anxiety is a prominent concern in Parkinson's disease (PD) that negatively impacts quality of life, increases functional disability, and complicates clinical management. Atypical presentations of anxiety are under-recognized and inadequately treated in patients with PD, compromising global PD care. METHODS This systematic review focuses on the prevalence, symptomology and clinical correlates of atypical presentations of PD-related anxiety following PRISMA guidelines. RESULTS Of the 60 studies meeting inclusion criteria, 14 focused on 'Anxiety Not Otherwise Specified (NOS)' or equivalent, 31 reported on fluctuating anxiety symptoms, and 22 reported on 'Fear of Falling (FOF)'. Anxiety NOS accounted for a weighted mean prevalence of 14.9%, fluctuating anxiety for 34.19%, and FOF for 51.5%. These latter two exceeded the average reported overall prevalence rate of 31% for anxiety disorders in PD. We identified a diverse array of anxiety symptoms related to motor and non-motor symptoms of PD, to complications of PD medication (such as "on" and "off" fluctuations, or both), and, to a lesser extent, to cognitive symptoms. CONCLUSION Atypical anxiety is common, clinically relevant, and heterogeneous in nature. A better understanding of the phenomenology, clinical course, and pathophysiology of varied forms of atypical anxiety in PD is needed to improve recognition, advance therapeutic development and ultimately optimize quality of life in PD.
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Affiliation(s)
- Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine (NND, EJF), The University of Queensland, Brisbane, Australia; School of Psychology (NND, EJF), University of Queensland, Brisbane, Australia; Department of Neurology (NND), Royal Brisbane & Women's Hospital, Brisbane, Australia.
| | - Elana J Forbes
- UQ Centre for Clinical Research, Faculty of Medicine (NND, EJF), The University of Queensland, Brisbane, Australia; School of Psychology (NND, EJF), University of Queensland, Brisbane, Australia
| | - Kate Perepezko
- Department of Mental Health (KP), Johns Hopkins University Blomberg School of Public Health, Baltimore, USA
| | - Albert F G Leentjens
- Department of Psychiatry (AFGL), Maastricht University Medical Center, Maastricht, the Netherlands
| | - Roseanne D Dobkin
- Department of Psychiatry (RDD), Rutgers University, Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Kathy Dujardin
- Department of Neurology and Movement Disorders (KD), University Lille, Lille, France
| | - Gregory M Pontone
- Department of Psychiatry and Behavioral Sciences (GMP), Johns Hopkins University School of Medicine, Baltimore, USA; Department of Neurology (GMP), Johns Hopkins University School of Medicine, Baltimore, USA
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Lebel S, Mutsaers B, Tomei C, Leclair CS, Jones G, Petricone-Westwood D, Rutkowski N, Ta V, Trudel G, Laflamme SZ, Lavigne AA, Dinkel A. Health anxiety and illness-related fears across diverse chronic illnesses: A systematic review on conceptualization, measurement, prevalence, course, and correlates. PLoS One 2020; 15:e0234124. [PMID: 32716932 PMCID: PMC7384626 DOI: 10.1371/journal.pone.0234124] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 05/19/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with chronic diseases commonly report fears of illness or symptoms recurring or worsening. These fears have been addressed from an illness-specific perspective (e.g., fear of cancer recurrence), a generic illness perspective (e.g., fear of progression), and a psychiatric perspective (DSM-5 illness anxiety disorder and somatic symptom disorder). The broader concept of health anxiety (HA) can also be applied to patients with a chronic disease. This review was conducted to investigate the conceptual, theoretical, measurement-overlap, and differences between these distinct perspectives. We also aimed to summarize prevalence, course, and correlates of these fears in different chronic illnesses. METHODS We used PsycINFO, PubMED, CINAHL, Web of Science, SCOPUS, and PSYNDEX to conduct a systematic review of studies pertaining to these fears in chronic illness published from January 1996 to October 2017. A total of 401 articles were retained. RESULTS There were commonalities across different conceptualizations and diseases: a high prevalence of clinical levels of fears (>20%), a stable course over time, and a deleterious impact on quality of life. Reviewed studies used definitions, models, and measures that were illness-specific, with only a minority employing a psychiatric perspective, limiting cross-disease generalizability. There appears to be some applicability of DSM-5 disorders to the experience of fear of illness/symptoms in patients with a chronic illness. While conceptualizing HA on a continuum ranging from mild and transient to severe may be appropriate, there is a lack of agreement about when the level of fear becomes 'excessive.' The definitions, models, and measures of HA across chronic illnesses involve affective, cognitive, behavioral, and perceptual features. CONCLUSIONS The concept of HA may offer a unifying conceptual perspective on the fears of illness/symptoms worsening or returning commonly experienced by those with chronic disease.
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Affiliation(s)
- Sophie Lebel
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Christina Tomei
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Georden Jones
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Nicole Rutkowski
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Viviane Ta
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Geneviève Trudel
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
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Joseph C, Leavy B, Franzén E. Predictors of improved balance performance in persons with Parkinson's disease following a training intervention: analysis of data from an effectiveness-implementation trial. Clin Rehabil 2020; 34:837-844. [PMID: 32362132 DOI: 10.1177/0269215520917199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE (1) To determine associated factors of improved balance performance after a 10-week HiBalance intervention period, and (2) to determine effects of the programme on modifiable factors found above, considering both groups. DESIGN Pre-posttest substudy founded on the outcomes evaluation of an effectiveness-implementation trial. PARTICIPANTS Sixty-one participants were allocated the HiBalance training, while 56 were controls. INTERVENTION Participants received a 10-week, two times weekly, progressive balance training, that is, HiBalance intervention, led by physical therapists. The intervention was group based and gradually incorporated dual-tasking over the training period. Participants also performed, unsupervised, a 1×/week home exercise programme. MAIN OUTCOME The Mini-Balance Evaluation Systems Test (Mini-BESTest) assessed balance performance, and those having improved by ⩾2 points were classified as positive responders. Balance confidence was the secondary outcome. RESULTS Fifty-three (87%) participants completed the intervention and 32 (60%) improved their balance scores by ⩾2 points in the intervention group, with 11 (24%) in the control group. The multivariable logistic regression analysis revealed two independently associated factors of improved balance, which included balance confidence (odds ratio (OR) = 0.95; 95% confidence interval (CI) = 0.90-0.99) and attendance of ⩾80% of training sessions (OR = 10.10; 95% CI = 1.71-59.60). The final model demonstrated good fit and acceptable discrimination (area under the curve = 0.84). Secondary analysis revealed a fair relationship (Rho = 0.30; P = 0.044) between improvements in balance confidence and balance performance in the intervention but not control group. CONCLUSION Two personal factors were significantly associated with a higher likelihood of improvement in clinically measured balance performance. The HiBalance intervention appears to benefit those with lower balance confidence.
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Affiliation(s)
- Conran Joseph
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
| | - Breiffni Leavy
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Flemingsberg, Sweden.,Stockholms Sjukhem Foundation, Stockholm, Sweden
| | - Erika Franzén
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Flemingsberg, Sweden.,Stockholms Sjukhem Foundation, Stockholm, Sweden.,Function Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
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Chung YC, Lewthwaite R, Winstein CJ, Monterosso JR, Fisher BE. Expectancy and affective response to challenging balance practice conditions in individuals with Parkinson's disease. Eur J Neurosci 2020; 52:3652-3662. [PMID: 32176392 DOI: 10.1111/ejn.14723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 02/10/2020] [Accepted: 03/03/2020] [Indexed: 11/27/2022]
Abstract
Psychological states can influence motor performance and learning. In Parkinson's disease (PD), placebo effects or expectancies for pharmacological treatment benefits are not uncommon, but little is known about whether self-efficacy, beliefs about personal performance capabilities, may play a role in this population. To address this question, we investigated whether experimental manipulations designed to enhance self-efficacy would benefit motor performance and learning in PD. A motor learning paradigm was utilized to determine the short-term (i.e., practice) and longer-term (i.e., retention) impact of self-efficacy enhancement when 44 individuals with PD (Hoehn and Yahr stage I-III) acquired a challenging balance skill. Using stratified randomization by Hoehn and Yahr stage, participants were assigned to a control group or one of two investigational groups: (a) an expectancy-relevant statement that encouraged an incremental mindset in which the balance skill, though initially challenging, was acquirable with practice (incremental theory group, IT), and (b) the expectancy-relevant statement in combination with a criterion for successful performance (incremental theory plus success criteria group, IT + SC). All groups improved their balance performance, but contrary to expectations, investigational groups did not outperform the control group at practice or retention. Unexpectedly, the IT + SC group reported greater nervousness than the control and IT groups, suggesting that the employed success criteria may have induced performance-related anxiety. Regression analyses revealed that self-efficacy increase from initial practice predicted performance at the end of practice and at retention. These findings highlight the potential contribution of psychological factors on motor function and rehabilitation in individuals with PD.
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Affiliation(s)
- Yu-Chen Chung
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Rebecca Lewthwaite
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA.,Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
| | - Carolee J Winstein
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA.,Department of Neurology, University of Southern California, Los Angeles, CA, USA
| | - John R Monterosso
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Beth E Fisher
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA.,Department of Neurology, University of Southern California, Los Angeles, CA, USA
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