Effects of physiotherapy and home-based training in parkinsonian syndromes: protocol for a randomised controlled trial (MobilityAPP)

INTRODUCTION

Gait and mobility impairment are pivotal signs of parkinsonism, and they are particularly severe in atypical parkinsonian disorders including multiple system atrophy (MSA) and progressive supranuclear palsy (PSP). A pilot study demonstrated a significant improvement of gait in patients with MSA of parkinsonian type (MSA-P) after physiotherapy and matching home-based exercise, as reflected by sensor-based gait parameters. In this study, we aim to investigate whether a gait-focused physiotherapy (GPT) and matching home-based exercise lead to a greater improvement of gait performance compared with a standard physiotherapy/home-based exercise programme (standard physiotherapy, SPT).

METHODS AND ANALYSIS

This protocol was deployed to evaluate the effects of a GPT versus an active control undergoing SPT and matching home-based exercise with regard to laboratory gait parameters, physical activity measures and clinical scales in patients with Parkinson's disease (PD), MSA-P and PSP. The primary outcomes of the trial are sensor-based laboratory gait parameters, while the secondary outcome measures comprise real-world derived parameters, clinical rating scales and patient questionnaires. We aim to enrol 48 patients per disease group into this double-blind, randomised-controlled trial. The study starts with a 1 week wearable sensor-based monitoring of physical activity. After randomisation, patients undergo a 2 week daily inpatient physiotherapy, followed by 5 week matching unsupervised home-based training. A 1 week physical activity monitoring is repeated during the last week of intervention.

ETHICS AND DISSEMINATION

This study, registered as 'Mobility in Atypical Parkinsonism: a Trial of Physiotherapy (Mobility_APP)' at clinicaltrials.gov (NCT04608604), received ethics approval by local committees of the involved centres. The patient's recruitment takes place at the Movement Disorders Units of Innsbruck (Austria), Erlangen (Germany), Lausanne (Switzerland), Luxembourg (Luxembourg) and Bolzano (Italy). The data resulting from this project will be submitted to peer-reviewed journals, presented at international congresses and made publicly available at the end of the trial.

TRIAL REGISTRATION NUMBER

NCT04608604.

Feasibility of an individualised, task-oriented, video-supported home exercise programme for arm function in patients in the subacute phase after stroke: protocol of a randomised controlled pilot study

INTRODUCTION

Stroke rehabilitation guidelines suggest a high-frequency task-oriented training at high intensity. A targeted and self-paced daily training with intermittent supervision is recommended to improve patients' self-management and functional output. So far, there is conflicting evidence concerning the most effective home-training delivery method.

METHODS AND ANALYSIS

The purpose of this pilot study is to compare the feasibility and preliminary effects of task-oriented home-exercises in patients in the subacute stage after stroke. Twenty-four patients will be randomised (1:1) to a Video group (a) or Paper group (b) of an individualised, task-oriented home-training (50 min, 6×/week, for 4 weeks) based on Wulf and Lewthwaite's Optimizing Performance Through Intrinsic Motivation and Attention for Learning theory of motor learning. Patient-relevant goals will be identified using Goal Attainment Scaling and exercises progressively adapted. Semistructured interviews and a logbook will be used to monitor adherence, arm use and acceptability. Primary outcome will be the feasibility of the methods and a full-scale trial employing predefined feasibility criteria (recruitment, retention and adherence rates, patients' satisfaction with the home-exercise programme and their progress, affected hand use and acceptance of the intervention). Assessed at baseline, post intervention and 4-week follow-up, secondary outcomes include self-perceived hand and arm use, actual upper extremity function and dexterity, hand strength, independence in activities of daily living and health-related quality of life. Interview data will be analysed using qualitative content analysis. Medians (ranges) will be reported for ordinal data, means (SD) for continuous and frequency (percentage) for nominal data.

ETHICS AND DISSEMINATION

This study follows the Standard Protocol Items: Recommendations for Interventional Trials-Patient-Reported Outcome (PRO) Extension guideline. Ethical approval was received from the Ethics Committee of the Medical University of Innsbruck, Austria (1304/2020). Written informed consent will be obtained from all participants prior to data collection. Study results will be disseminated to participating patients, patient organisations, via the clinic's homepage, relevant conferences and peer-reviewed journals.

TRIAL REGISTRATION NUMBER

DRKS-ID: DRKS00023395.Study protocol, second revision, 5 December 2021.

Hard rod gas with long-range interactions: Exact predictions for hydrodynamic properties of continuum systems from discrete models

One-dimensional hard rod gases are explicitly constructed as the limits of discrete systems: exclusion processes involving particles of arbitrary length. Those continuum many-body systems in general do not exhibit the same hydrodynamic properties as the underlying discrete models. Considering as examples a hard rod gas with additional long-range interaction and the generalized asymmetric exclusion process for extended particles, it is shown how a correspondence between continuous and discrete systems must be established instead. This opens up a possibility to exactly predict the hydrodynamic behavior of this continuum system under Eulerian scaling by solving its discrete counterpart with analytical or numerical tools. As an illustration, simulations of the totally asymmetric exclusion process are compared to analytical solutions of the model and applied to the corresponding hard rod gas. The case of short-range interaction is treated separately.

Effect of flavonoids on daunomycin-induced toxicity in cultivated endothelial cells

The cytotoxicity of daunomycin in cultivated endothelial cells was differentially influenced by selected flavonoids. One group (myricetin, flavone, apigenin) enhanced daunomycin toxicity whereas flavonols like quercetin, kaempferol, rutin and morin significantly inhibited this cytotoxicity. Other flavonoids like hesperidin, naringin and catechin did not interact with the daunomycin-induced inhibition of proliferation. There was no correlation between lipophilicity and toxicity of the flavonoids and the observed effects on daunomycin-induced cytotoxity. The protective effect of quercetin and rutin seems to be connected with the antioxidative properties of these flanonols.

Fluctuating bond model of DNA gel electrophoresis

We present a Monte Carlo algorithm that allows a small length scale numerical study of DNA gel electrophoresis in high electric fields, similar to the fluctuating bond model for dynamical properties of polymeric systems. This approach combines advantages of lattice Monte Carlo methods with those from continuous Brownian dynamics algorithms, and also takes into account the persistence length of DNA, as well as the random nature of the gel. The initial orientation and acceleration of a random-walk DNA conformation shows a number of features that can be related to experimental results. The detailed description of DNA motion provided by this approach may lead to a first realistic computer study of the process of DNA sequencing.

[Corpus cavernosum injection treatment of erectile impotence]

Through the use of vasoactive substances an improvement of diagnosis and treatment of men suffering from erectile dysfunction was obtained. From June 1988 to December 1989 in 108 patients an intracavernous injection therapy trial was performed. The response rate 85% and in 69% of the patients an organic disorders was found. Five percent of the patients have had a prolonged erection after intracavernous papaverine phentolamine injection. All cases have been treated successfully by local use of the sympaticomimetics Noradrenaline. The use of vasoactive substances is the method of choice in diagnosis and treatment of erectile dysfunction.