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Land plus aquatic therapy versus land-based rehabilitation alone for the treatment of freezing of gait in Parkinson disease: a randomized, controlled study
Clerici I, Maestri R, Bonetti F, Ortelli P, Volpe D, Ferrazzoli D, Frazzitta G
Physical Therapy 2019 May 1;99(5):591-600
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Freezing of gait (FOG) is one of the most disabling symptoms of Parkinson disease (PD). It has been found that different land-based rehabilitation approaches based on motor and cognitive strategies could be effective for treating FOG. At the same time, there are data about the efficacy of aquatic therapy (AT) in ameliorating this phenomenon. No 1 study has explored the combined effect of land plus AT in patients with PD who have FOG. OBJECTIVE: The objective was to investigate the effectiveness of a multidisciplinary, intensive, motor-cognitive rehabilitation treatment (MIRT) in improving FOG and whether the implementation with AT (MIRT-AT) adds further benefits. DESIGN: The design consisted of a single-blind, parallel group, 1:1 allocation ratio, randomized trial. SETTING: Department of Parkinson disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital (Gravedona ed Uniti, Como-Italy) was used as the setting. PARTICIPANTS: 60 hospitalized patients with PD who had FOG in Hoehn and Yahr (H and Y) stage 2 or 5 to 3 were included. Intervention: 60 patients with PD plus FOG were randomly assigned to 2 groups. 30 underwent a 4-week MIRT and 30 underwent a 4-week MIRT plus AT (MIRT-AT). MEASUREMENTS: The primary outcome measure was the Freezing of Gait Questionnaire (FOGQ); secondary outcome measures were total Unified Parkinson Disease Rating Scale (UPDRS), UPDRS II, UPDRS III, Berg Balance Scale (BBS), Timed Up and Go Test (TUG) and 6-Minute Walk Test (6MWT). These measures were assessed both at admission and discharge. RESULTS: Patients in the two groups had similar age, gender distribution, H and Y stage, and most-affected side. At baseline, no difference in outcome measures was observed between the two groups. After treatment, a significant time effect was observed for all variables in both groups. No significant time x-group interaction was observed. A between-group analysis showed non-significant differences between values at T1 and values at T0 for all variables. Limitations: A limitation is that control group and follow-up are lacking. CONCLUSIONS: We showed that a multidisciplinary, intensive, and goal-based rehabilitation treatment, such as MIRT, improve FOG in patients with PD. Even though AT could be considered as a useful approach for treating FOG, it does not add further benefits to this kind of motor-cognitive rehabilitation.

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