February 2007
A Nieuwboer, G Kwakkel, L Rochester, D Jones, E van Wegen, A M Willems, F Chavret, V Hetherington, K Baker, I Lim
Objectives: Gait and mobility problems are
difficult to treat in people with Parkinson’s disease. The
Rehabilitation in Parkinson’s Disease: Strategies for Cueing (RESCUE)
trial investigated the effects of a home physiotherapy programme based
on rhythmical cueing on gait and gait-related activity.
Methods: A
single-blind randomised crossover trial was set up, including 153
patients with Parkinson’s disease aged between 41 and 80 years and in
Hoehn and Yahr stage II–IV. Subjects allocated to early intervention
(n = 76) received a 3-week home cueing programme using a prototype
cueing device, followed by 3 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 6-week follow-up without training. Posture and gait scores (PG
scores) measured at 3, 6 and 12 weeks by blinded 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%
in freezers only (p = 0.007). Gait speed (p = 0.005), step length
(p<0.001) 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 had reduced considerably at 6-week follow-up.
Conclusions:
Cueing training in the home has specific effects on gait, freezing and
balance. The decline in effectiveness 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 Parkinson’s disease.
