Cueing training in the home improves gait-related mobility in Parkinson's disease: The RESCUE-trial
Nieuwboer, Alice × Kwakkel, Gert Rochester, Lynn Jones, Diana van Wegen, Erwin Willems, Anne Marie Chavret, Fabienne Hetherington, Victoria Baker, Katherine Lim, Inge #
British Medical Association
Journal of Neurology, Neurosurgery and Psychiatry vol:78 issue:2 pages:134-140
OBJECTIVES: Gait and mobility problems remain difficult to treat in people with Parkinson's disease (PD). The RESCUE-trial investigated the effects of a home physiotherapy program based on rhythmical cueing on gait and gait-related activity. METHODS: A single-blind randomized cross-over trial was set up, including 153 patients with PD aged between 41 and 80 years and in Hoehn & Yahr stage II to IV. Subjects allocated to early intervention (N=76) received a three-week home cueing program using a prototype cueing device followed by three weeks without training. Patients allocated to late intervention (N=77) underwent the same intervention and control period in reverse order. After the initial 6 weeks, both groups had a six week follow-up without training. Posture and Gait scores (PG-scores) measured at 3, 6, and 12 weeks by blind testers were the primary outcome measure. Secondary outcomes included specific measures on gait, freezing and balance, functional activities, quality of life and carer strain. RESULTS: Small but significant improvements were found after intervention of 4.2% on the PG-scores (p=0.005). Severity of freezing was reduced by 5.5% as measured in freezers only (p=0.007). Gait speed (p=0.005), step length (p<.0001) and timed balance tests (p=0.003) improved in the full cohort. Other than a greater confidence to carry out functional activities (Falls Efficacy Scale, p=0.04), no carry-over effects were observed in functional and quality of life domains. Effects of intervention reduced significantly at 6 week follow-up. CONCLUSIONS: Cueing training in the home has specific effects on gait, freezing and balance. The wearing off of intervention effects underscores the need for permanent cueing devices and follow-up treatment. Cueing training may be a useful therapeutic adjunct to the overall management of gait disturbance in PD.