Non-pharmacological interventions such as physiotherapy are recognized as important elements in the overall clinical management of motor impairments in PD, but evidence of physiotherapy in advanced disease stages is sparse. A recent trial found positive effects of multimodal balance training in people with mild to moderate PD, with greater and more sustained effects when rhythmical auditory stimuli were added. It is unclear whether such multimodal balance training is also effective in people with advanced PD (Hoehn & Yahr stage 4). METHODS We performed a pilot prospective single-blind, randomized clinical trial to study the effectiveness of multimodal training with and without rhythmical auditory stimuli. We screened 76 people with Parkinson's disease and Hoehn & Yahr stage 4 by telephone; 35 patients were assigned randomly into two groups: (1) multimodal balance training with rhythmical auditory stimuli (RAS-supported intervention, n = 17) and (2) multimodal balance training without rhythmical auditory cues (n = 18). Training was performed for 5 weeks, two times/week. Primary outcome was the Mini-BESTest (MBEST) score immediately after the training period. Assessments were performed by the same two blinded assessors at baseline, immediately post intervention, and after one and 6-months follow-up. RESULTS Immediately post-intervention, both intervention groups improved significantly on Mini-Best scores, without differences between both intervention modalities. In both groups, results were retained at one-month follow-up. At 6-months follow-up, the effects were retained only in the RAS-supported intervention group. For both intervention groups, no improvements were found on secondary outcome measures for gait. CONCLUSION Both RAS-supported multimodal balance training and regular multimodal balance training improve balance in PD patients in advanced disease stages. Effects appear to sustain longer in the RAS-supported training group.

中文翻译：

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有节奏的听觉刺激支持的多模式平衡训练对帕金森病晚期患者的影响：一项试点随机临床试验

物理治疗等非药物干预被认为是 PD 运动障碍整体临床管理的重要因素，但在疾病晚期阶段进行物理治疗的证据很少。最近的一项试验发现，多模式平衡训练对轻度至中度 PD 患者有积极影响，当添加有节奏的听觉刺激时，效果更大、更持久。目前尚不清楚这种多模式平衡训练是否对晚期 PD 患者也有效（Hoehn & Yahr 阶段 4）。方法 我们进行了一项试点前瞻性单盲、随机临床试验，以研究有和没有有节奏的听觉刺激的多模式训练的有效性。我们通过电话筛查了 76 名帕金森病患者和 Hoehn & Yahr 4 期患者；35 名患者被随机分为两组：(1) 有节奏听觉刺激的多模式平衡训练（RAS 支持的干预，n = 17）和（2）没有节奏听觉线索的多模式平衡训练（n = 18）。训练进行了 5 周，每周两次。主要结果是训练期后立即的 Mini-BESTest (MBEST) 分数。在基线、干预后即刻以及 1 个月和 6 个月的随访后，由相同的两名盲法评估者进行评估。结果 干预后即刻，两个干预组的 Mini-Best 评分均显着提高，两种干预方式之间没有差异。在两组中，结果在 1 个月的随访中得以保留。在 6 个月的随访中，效果仅在 RAS 支持的干预组中得以保留。对于两个干预组，步态的次要结果指标均未发现改善。结论 RAS 支持的多模式平衡训练和常规多模式平衡训练均可改善晚期 PD 患者的平衡。在 RAS 支持的培训组中，效果似乎持续更长时间。