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Nuic D, van de Weijer S, Cherif S, Skrzatek A, Zeeboer E, Olivier C, Corvol JC, Foulon P, Pastor JZ, Mercier G, Lau B, Bloem BR, De Vries NM, Welter ML. Home-based exergaming to treat gait and balance disorders in patients with Parkinson's disease: A phase II randomized controlled trial. Eur J Neurol 2024; 31:e16055. [PMID: 37691341 DOI: 10.1111/ene.16055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 07/26/2023] [Accepted: 08/21/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Exergaming has been proposed to improve gait and balance disorders in Parkinson's disease (PD) patients. We aimed to assess the efficacy of a home-based, tailored, exergaming training system designed for PD patients with dopa-resistant gait and/or balance disorders in a controlled randomized trial. METHODS We recruited PD patients with dopa-resistant gait and/or balance disorders. Patients were randomly assigned (1:1 ratio) to receive 18 training sessions at home by playing a tailored exergame with full-body movements using a motion capture system (Active group), or by playing the same game with the computer's keyboard (Control group). The primary endpoint was the between-group difference in the Stand-Walk-Sit Test (SWST) duration change after training. Secondary outcomes included parkinsonian clinical scales, gait recordings, and safety. RESULTS Fifty PD patients were enrolled and randomized. After training, no significant difference in SWST change was found between groups (mean change SWST duration [SD] -3.71 [18.06] s after Active versus -0.71 [3.41] s after Control training, p = 0.61). Some 32% of patients in the Active and 8% in the Control group were considered responders to the training program (e.g., SWST duration change ≥2 s, p = 0.03). The clinical severity of gait and balance disorders also significantly decreased after Active training, with a between-group difference in favor of the Active training (p = 0.0082). Home-based training induced no serious adverse events. CONCLUSIONS Home-based training using a tailored exergame can be performed safely by PD patients and could improve gait and balance disorders. Future research is needed to investigate the potential of exergaming.
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Affiliation(s)
- Dijana Nuic
- Paris Brain Institute, CNRS UMR 7225, INSERM 1127, Sorbonne University, Paris, France
- LabCom Brain e-Novation, Paris Brain Institute, Paris, France
| | - Sjors van de Weijer
- Donders Institute for Brain, Cognition, and Behavior and Department of Neurology, Center of Expertise for Parkinson and Movement, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Saoussen Cherif
- Paris Brain Institute, CNRS UMR 7225, INSERM 1127, Sorbonne University, Paris, France
- LabCom Brain e-Novation, Paris Brain Institute, Paris, France
| | - Anna Skrzatek
- Paris Brain Institute, CNRS UMR 7225, INSERM 1127, Sorbonne University, Paris, France
| | - Eline Zeeboer
- Donders Institute for Brain, Cognition, and Behavior and Department of Neurology, Center of Expertise for Parkinson and Movement, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Claire Olivier
- Paris Brain Institute, CNRS UMR 7225, INSERM 1127, Sorbonne University, Paris, France
- PANAM core facility, INSERM 1127, Paris Brain Institute, Paris, France
| | - Jean-Christophe Corvol
- Paris Brain Institute, CNRS UMR 7225, INSERM 1127, Sorbonne University, Paris, France
- Clinical Investigation Center, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Pierre Foulon
- LabCom Brain e-Novation, Paris Brain Institute, Paris, France
- GENIOUS Healthcare, Montpellier, France
| | - Jénica Z Pastor
- Biostatistics Department, CHU de Montpellier, Montpellier, France
| | - Gregoire Mercier
- Biostatistics Department, CHU de Montpellier, Montpellier, France
- IDESP UA11, Université de Montpellier, INSERM, Montpellier, France
| | - Brian Lau
- Paris Brain Institute, CNRS UMR 7225, INSERM 1127, Sorbonne University, Paris, France
| | - Bastiaan R Bloem
- Donders Institute for Brain, Cognition, and Behavior and Department of Neurology, Center of Expertise for Parkinson and Movement, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nienke M De Vries
- Donders Institute for Brain, Cognition, and Behavior and Department of Neurology, Center of Expertise for Parkinson and Movement, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marie-Laure Welter
- Paris Brain Institute, CNRS UMR 7225, INSERM 1127, Sorbonne University, Paris, France
- LabCom Brain e-Novation, Paris Brain Institute, Paris, France
- PANAM core facility, INSERM 1127, Paris Brain Institute, Paris, France
- CHU Rouen, Neurophysiology Department, Rouen University, Rouen, France
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Langbroek-Amersfoort A, Schootemeijer S, Bouten L, Bloem BR, De Vries NM. Exercise Made Accessible: the Merits of Community-Based Programs for Persons with Parkinson's Disease. Curr Neurol Neurosci Rep 2023; 23:695-715. [PMID: 37792207 PMCID: PMC10673991 DOI: 10.1007/s11910-023-01303-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE OF REVIEW Many studies have identified positive effects of physiotherapy and exercise for persons with Parkinson's disease (PD). Most work has thus far focused on the therapeutic modality of exercise as used within physiotherapy programs. Stimulated by these positive findings, there is now a strong move to take exercise out of the clinical setting and to deliver the interventions in the community. Although the goals and effects of many such community-based exercise programs overlap with those of physiotherapy, it has also become more clear that both exercise modalities also differ in various ways. Here, we aim to comprehensively review the evidence for community-based exercise in PD. RECENT FINDINGS Many different types of community-based exercise for people with PD are emerging and they are increasingly being studied. There is a great heterogeneity considering the types of exercise, study designs, and outcome measures used in research on this subject. While this review is positive regarding the feasibility and potential effects of community-based exercise, it is also evident that the general quality of these studies needs improvement. By focusing on community-based exercise, we hope to generate more knowledge on the effects of a wide range of different exercise modalities that can be beneficial for people with PD. This knowledge may help people with PD to select the type and setting of exercise activity that matches best with their personal abilities and preferences. As such, these insights will contribute to an improved self-management of PD.
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Affiliation(s)
- Anneli Langbroek-Amersfoort
- Center of Expertise for Parkinson & Movement Disorders, Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sabine Schootemeijer
- Center of Expertise for Parkinson & Movement Disorders, Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lars Bouten
- Center of Expertise for Parkinson & Movement Disorders, Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Center of Expertise for Parkinson & Movement Disorders, Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nienke M De Vries
- Center of Expertise for Parkinson & Movement Disorders, Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands.
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Talebi AH, Ypinga JHL, De Vries NM, Nonnekes J, Munneke M, Bloem BR, Heskes T, Ben-Shlomo Y, Darweesh SKL. Specialized Versus Generic Allied Health Therapy and the Risk of Parkinson's Disease Complications. Mov Disord 2023; 38:223-231. [PMID: 36424819 DOI: 10.1002/mds.29274] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/04/2022] [Accepted: 10/27/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Specialized versus generic physiotherapy (PT) reduces Parkinson's disease (PD)-related complications. It is unclear (1) whether other specialized allied heath disciplines, including occupational therapy (OT) and speech and language therapy (S<), also reduce complications; (2) whether there is a synergistic effect among multiple specialized disciplines; and (3) whether each allied health discipline prevents specific complications. OBJECTIVES To longitudinally assessed whether the level of expertise (specialized vs. generic training) of PT, OT, and S< was associated with the incidence rate of PD-related complications. METHODS We used claims data of all insured persons with PD in the Netherlands between January 1, 2010, and December 31, 2018. ParkinsonNet-trained therapists were classified as specialized, and other therapists as generic. We used mixed-effects Poisson regression models to estimate rate ratios adjusting for sociodemographic and clinical characteristics. RESULTS The population of 51,464 persons with PD (mean age, 72.4 years; standard deviation 9.8) sustained 10,525 PD-related complications during follow-up (median 3.3 years). Specialized PT was associated with fewer complications (incidence rate ratio [IRR] of specialized versus generic = 0.79; 95% confidence interval, [0.74-0.83]; P < 0.0001), as was specialized OT (IRR = 0.88 [0.77-0.99]; P = 0.03). We found a trend of an association between specialized S< and a lower rate of PD-related complications (IRR = 0.88 [0.74-1.04]; P = 0.18). The inverse association of specialized OT persisted in the stratum, which also received specialized PT (IRR = 0.62 [0.42-0.90]; P = 0.001). The strongest inverse association of PT was seen with orthopedic injuries (IRR = 0.78 [0.73-0.82]; P < 0.0001) and of S< with pneumonia (IRR = 0.70 [0.53-0.93]; P = 0.03). CONCLUSIONS These findings support a wider introduction of specialized allied health therapy expertise in PD care and conceivably for other medical conditions. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Amir H Talebi
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
| | - Jan H L Ypinga
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
| | - Nienke M De Vries
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
| | - Jorik Nonnekes
- Department of Rehabilitation, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
| | - Marten Munneke
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
| | - Bas R Bloem
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
| | - Tom Heskes
- Institute for Computing and Information Sciences, Radboud University, Nijmegen, the Netherlands
| | - Yoav Ben-Shlomo
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Sirwan K L Darweesh
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
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Darweesh SK, De Vries NM, Helmich RC, Verbeek MM, Schwarzschild MA, Bloem BR. Inhibition of Neuroinflammation May Mediate the Disease-Modifying Effects of Exercise: Implications for Parkinson’s Disease. JPD 2022; 12:1419-1422. [PMID: 35466957 PMCID: PMC9398068 DOI: 10.3233/jpd-223216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Sirwan K.L. Darweesh
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nienke M. De Vries
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rick C. Helmich
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcel M. Verbeek
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Bastiaan R. Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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Bloem BR, Ypinga JHL, Willis A, Canning CG, Barker RA, Munneke M, De Vries NM. Using Medical Claims Analyses to Understand Interventions for Parkinson Patients. J Parkinsons Dis 2019; 8:45-58. [PMID: 29254108 PMCID: PMC5836412 DOI: 10.3233/jpd-171277] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The scientific evidence to support the value of a range of non-pharmacological interventions for people with Parkinson’s disease (PD) is increasing. However, showing unequivocally that specific interventions are better than usual care is not straightforward because of generic drawbacks of clinical trials. Here, we address these challenges, specifically related to the context of evaluating complex non-pharmacological interventions for people with PD. Moreover, we discuss the potential merits of undertaking “real world” analyses using medical claims data. We illustrate this approach by discussing an interesting recent publication in The Lancet Neurology, which used such an approach to demonstrate the value of specialized physiotherapy for PD patients, over and above usual care physiotherapy.
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Affiliation(s)
- Bastiaan R Bloem
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
| | - Jan H L Ypinga
- Department Care Purchasing, CZ Groep, Goes, The Netherlands
| | - Allison Willis
- Departments of Neurology and of Biostatistics, Epidemiology and Informatics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Colleen G Canning
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Roger A Barker
- Department of Clinical Neurosciences, John van Geest Centre for Brain Repair, University of Cambridge, UK
| | - Marten Munneke
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
| | - Nienke M De Vries
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
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