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Quinn L, Debono K, Dawes H, Rosser AE, Nemeth AH, Rickards H, Tabrizi SJ, Quarrell O, Trender-Gerhard I, Kelson MJ, Townson J, Busse M. Task-specific training in Huntington disease: a randomized controlled feasibility trial. Phys Ther 2014; 94:1555-68. [PMID: 25012999 DOI: 10.2522/ptj.20140123] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Task-specific training may be a suitable intervention to address mobility limitations in people with Huntington disease (HD). OBJECTIVE The aim of this study was to assess the feasibility and safety of goal-directed, task-specific mobility training for individuals with mid-stage HD. DESIGN This study was a randomized, blinded, feasibility trial; participants were randomly assigned to control (usual care) and intervention groups. SETTING This multisite study was conducted in 6 sites in the United Kingdom. PATIENTS Thirty individuals with mid-stage HD (13 men, 17 women; mean age=57.0 years, SD=10.1) were enrolled and randomly assigned to study groups. INTERVENTION Task-specific training was conducted by physical therapists in participants' homes, focusing on walking, sit-to-stand transfers, and standing, twice a week for 8 weeks. Goal attainment scaling was used to individualize the intervention and monitor achievement of personal goals. MEASUREMENTS Adherence and adverse events were recorded. Adjusted between-group comparisons on standardized outcome measures were conducted at 8 and 16 weeks to determine effect sizes. RESULTS Loss to follow-up was minimal (n=2); adherence in the intervention group was excellent (96.9%). Ninety-two percent of goals were achieved at the end of the intervention; 46% of the participants achieved much better than expected outcomes. Effect sizes on all measures were small. LIMITATIONS Measurements of walking endurance were lacking. CONCLUSIONS The safety of and excellent adherence to a home-based, task-specific training program, in which most participants exceeded goal expectations, are encouraging given the range of motivational, behavioral, and mobility issues in people with HD. The design of the intervention in terms of frequency (dose), intensity (aerobic versus anaerobic), and specificity (focused training on individual tasks) may not have been sufficient to elicit any systematic effects. Thus, a larger-scale trial of this specific intervention does not seem warranted.
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Affiliation(s)
- Lori Quinn
- L. Quinn, PT, PhD, School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom
| | - Katy Debono
- K. Debono, BSc AnatomicalScience(Hons), BSc Physiotherapy, MCSP, School of Healthcare Sciences, Cardiff University
| | - Helen Dawes
- H. Dawes, PhD, MMedSci, Movement Science Group, Oxford Brookes University, Oxford, United Kingdom
| | - Anne Elizabeth Rosser
- A.E. Rosser, PhD, MB, BChir, BA(Hons), Schools of Medicine and Biosciences, Cardiff University
| | - Andrea H Nemeth
- A.H. Nemeth, MB, BS, DPhil, CCST, Department of Clinical Genetics, Churchill Hospital, Oxford
| | - Hugh Rickards
- H. Rickards, MB, ChB, MMedSci, MRCPsych, MD, FRCPsych, The Barberry Centre, Birmingham, United Kingdom
| | - Sarah J Tabrizi
- S.J. Tabrizi, FRCP, PhD, FMedSci, BSc(Hons), Department of Neurodegenerative Diseases, UCL Institute of Neurology, University College London, Queen Square, London, United Kingdom
| | - Oliver Quarrell
- O. Quarrell, MD, FRCP, BSc, Sheffield Children's Hospital, Sheffield, United Kingdom
| | - Iris Trender-Gerhard
- I. Trender-Gerhard, MD, Institute of Human Development, University of Manchester, Manchester, St Mary's Hospital/Central Manchester Foundation Trust
| | - Mark J Kelson
- M.J. Kelson, PhD, MSc, BSc, South East Wales Trial Unit, Cardiff University School of Medicine
| | - Julia Townson
- J. Townson, BA(JointHons), South East Wales Trial Unit, Cardiff University School of Medicine
| | - Monica Busse
- M. Busse, PhD, MSc(Med), BSc(Med)Hons, MCSP, BSc(Physiotherapy), School of Healthcare Sciences, Cardiff University, Ty Dewi Sant, Heath Park, Cardiff, CF14 4XN United Kingdom.
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Quinn L, Debono K, Dawes H, Rosser A, Nemeth A, Quarrell O, Rickards H, Tabrizi S, Trender-Gerhard I, Kelson M, Townson J, Busse M. J05 Task-specific Training In Huntington's Disease: A Randomised, Controlled Feasibility Trial. Journal of Neurology, Neurosurgery & Psychiatry 2014. [DOI: 10.1136/jnnp-2014-309032.188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Jones K, Debono K, Quinn L, Rosser A, Busse M. J09 Physiotherapy Task Orientated Approach: A Case Report. Journal of Neurology, Neurosurgery & Psychiatry 2014. [DOI: 10.1136/jnnp-2014-309032.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Dawes H, Collett J, Debono K, Quinn L, Jones K, Kelson MJ, Simpson SA, Playle R, Backx K, Wasley D, Nemeth AH, Rosser A, Izardi H, Busse M. Exercise testing and training in people with Huntington's disease. Clin Rehabil 2014; 29:196-206. [PMID: 25142278 DOI: 10.1177/0269215514540921] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To explore exercise response in people with Huntington's disease (HD). DESIGN Experimental observational study with a randomly allocated subgroup before/after interventional study. SETTING Community. SUBJECTS People with HD (n=30) and a healthy comparator group (n=20). Thirteen people from the HD group were randomly allocated to an exercise training program. MAIN MEASURES Heart rate (HR) and perceived exertion on the Borg-CR10 scale (RPE) during a submaximal cycle ergometer exercise test (three minute unloaded and nine minute 65%-75%HRmaximum phase). Expired air and lactate measures were available for 8 people with HD during the exercise. INTERVENTION A 12 week gym and home walking exercise programme (n=13). RESULTS People with HD achieved a lower work rate at nine minutes (82±42(0-195) v 107±35(50 -185) Watts (p<0.05)), but higher RPE at both three (3±2(0-7) v 1±1(0-4)) and nine minutes (7±3(1-10) v 5± 2(2-9)) both p<0.01, compared to the healthy group and did not achieve a steady state HR during unloaded cycling. People with HD also demonstrated higher than expected lactate at three 2.5±2.5(1.1-8)mmo.L-1 and nine 3.8±1.9(1.2-6.6)mmo.L-1 minutes and respiratory exchange ratio at three 0.78±0.03 (0.74-0.81) and nine minutes 0.94±0.11(0.81-1.15). After exercise training there were no changes observed in HR or RPE responses during the exercise test. CONCLUSIONS There was a large variability in the observed metabolic and physiological responses to exercise in people with HD. The observed exercise responses suggest that altered exercise prescription parameters may be required for people with HD and that exercise response and factors' affecting this requires further investigation.
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Affiliation(s)
- H Dawes
- Movement Science Group, Faculty of Health and Life Sciences, Oxford Brookes University, UK Department of Clinical Neurology University of Oxford, UK
| | - J Collett
- Movement Science Group, Faculty of Health and Life Sciences, Oxford Brookes University, UK
| | - K Debono
- School of Healthcare Sciences, Cardiff University, UK
| | - L Quinn
- School of Healthcare Sciences, Cardiff University, UK
| | - K Jones
- School of Healthcare Sciences, Cardiff University, UK
| | - M J Kelson
- Institute for Translation, Innovation, Methodology and Engagement (TIME), Cardiff University School of Medicine, UK
| | - S A Simpson
- Institute for Translation, Innovation, Methodology and Engagement (TIME), Cardiff University School of Medicine, UK
| | - R Playle
- Institute for Translation, Innovation, Methodology and Engagement (TIME), Cardiff University School of Medicine, UK
| | - K Backx
- Cardiff Metropolitan University, Cardiff School of Sport, UK
| | - D Wasley
- Cardiff Metropolitan University, Cardiff School of Sport, UK
| | - A H Nemeth
- Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - A Rosser
- Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, UK Cardiff Brain Repair Group, School of BioSciences, Cardiff University, UK
| | - H Izardi
- School of Technology, Oxford Brookes University, UK
| | - M Busse
- School of Healthcare Sciences, Cardiff University, UK
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