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Trunk exercises improve balance in Parkinson disease: a phase II randomized controlled trial
Hubble RP, Silburn PA, Naughton GA, Cole MH
Journal of Neurologic Physical Therapy 2019 Apr;43(2):96-105
clinical trial
4/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: No; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND AND PURPOSE: Trunk control is important for maintaining balance; hence, deficient trunk control may contribute to balance problems in people with Parkinson disease (PD). Unfortunately, this deficit is poorly managed with pharmacological therapies, emphasizing the need for alternative therapies for these patients. This randomized controlled trial sought to examine the effects of a 12-week trunk-specific exercise-based intervention on balance in people with PD. METHODS: Twenty-four people with PD and with a history of falls completed assessments of motor symptom severity, balance confidence, mobility, quality of life, and quiet-standing balance. Participants were then randomized to receive either 12 weeks of exercise or education and reassessed after 12 and 24 weeks. RESULTS: Linear mixed-models analyses showed no significant changes in clinical outcomes following the intervention. However, during quiet standing, sway area on a foam surface without vision was reduced for the exercise group at 12 (-6.9 +/- 3.1 cm; 95% confidence interval (CI) -13.1 to -0.7; p = 0.029; d 0.66) and 24 weeks (-7.9 +/- 3.1 cm; 95% CI -14.1 to -1.7; p = 0.013; d 0.76). Furthermore, the exercise group demonstrated reduced sway variability at 12 (-0.2 +/- 0.1 cm; 95% CI -0.4 to 0.0; p = 0.042; d 0.62) and 24 weeks in the medial-lateral direction (-0.2 +/- 0.1 cm; 95% CI -0.4 to 0.0; p = 0.043; d 0.62). No changes in quiet standing balance were recorded for the education group. DISCUSSION AND CONCLUSIONS: The results of this study suggest that exercise-based interventions targeting trunk strength, endurance, and mobility may be effective for improving quiet-standing balance in people with PD. However, additional research is needed to determine whether these improvements are sufficient to reduce falls risk.

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