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physioscience 2015; 11(02): 62-67
DOI: 10.1055/s-0034-1399635
Zweitpublikation
© Georg Thieme Verlag KG Stuttgart · New York

Potenzialanalyse zur physiotherapeutischen Laufbandtherapie bei Morbus Parkinson

Potential Analysis for Research on Physiotherapy-led Treadmill Training in Parkinson’s Disease
M Lohkamp .
1   Fakultät für Therapiewissenschaften, SRH Hochschule Heidelberg
,
C. Braun
2   hochschule 21, Buxtehude
,
M. Wasner
1   Fakultät für Therapiewissenschaften, SRH Hochschule Heidelberg
,
S. Voigt-Radloff
3   Deutsches Cochrane Zentrum, Universitätsklinikum Freiburg
› Author Affiliations
Further Information

Publication History

23 January 2015

25 January 2015

Publication Date:
28 May 2015 (online)

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Zusammenfassung

Gesundheitsproblem: M. Parkinson ist eine der häufigsten Erkrankungen des ZNS mit Prävalenzraten von 0,1 – 0,2 % in der Gesamtbevölkerung, 1,8 % bei über 65-Jährigen und steigender Tendenz bei der älter werdenden Bevölkerung in Deutschland. Die Erkrankung verläuft in Stadien und ruft unter anderem motorische Einschränkungen wie Bewegungsarmut, Steifheit und Zittern hervor, die wiederum zu einer Minderung der Lebensqualität und Teilhabe am Arbeits- und Sozialleben führen. M. Parkinson verursacht Arbeitsunfähigkeit und eine hohe Zahl an Fehltagen. Klienten erwarten von einer bewegungstherapeutischen Behandlung, dass Gehfähigkeit und Bewegungsgeschwindigkeit verbessert werden und Müdigkeit und Steifheit abnehmen.

Evidenzlage: Ein Cochrane-Review aus dem Jahre 2010 [19] belegt auf Basis von 7 randomisierten Vergleichen mit 153 Teilnehmern, dass Laufbandtraining verglichen mit keiner Therapie positive Wirkung auf die Gehgeschwindigkeit von Patienten mit Parkinson hat (SMD: 0,50; 95 %-KI: 0,17 – 0,84). Evidenzlücken bestehen in Bezug auf die Verringerung der Müdigkeit und Steifheit. Ebenso wurden weder Kosten noch mittel- oder langfristige Effekte der Therapie ausreichend untersucht. Weiterhin sind noch 11 neuere Studien ab 2009 mit 362 Teilnehmern zu berücksichtigen. Die Intervention ist in den deutschen Kontext sehr gut übertragbar, da die Voraussetzungen für eine Laufbandtherapie in vielen Einrichtungen der Routineversorgung gegeben sind.

Forschungsempfehlung: Für die Vorbereitung einer Wirksamkeitsstudie zu bewegungsbezogenen Endpunkten, Lebensqualität, Kosten, Nebeneffekten und Langzeitwirkung sollten in einer Machbarkeitsstudie zunächst Fragen der Akzeptanz und Intensität des Laufbandtrainings sowie der Zugang physiotherapeutischer Praxen zu Menschen mit Morbus Parkinson im leichten bis mittleren Stadium geklärt werden.

Abstract

Health problem: Parkinson’s disease is one of the major neurodegenerative disorders with prevalence rates of 0.1 – 0.2 % in the global population and 1.8 % in people aged 64 years and over. Future incidence rates are estimated to increase within aging societies. The progressive course of Parkinson’s disease is clinically characterized by bradykinesia, rigidity and tremor. These limitations in motor functioning reduce the capacity to work, social participation and the clients’ quality of life. Parkinson’s disease causes incapacity to work and a large number of days off from work. The benefits clients expect from physiotherapy-led treatment include an improvement of gait, a better speed of motion and the decrease of fatigue and rigidity.

Corpus of evidence: A recent Cochrane review [19] analysed 7 randomised comparisons with 153 participants and found that treadmill training compared with no treatment improved gait speed (SMD: 0.50; 95 % confidence interval: 0.17 – 0.84). A lack of evidence exists on how to reduce fatigue and rigidity. There is also need to evaluate long-term effects and cost-effectiveness. Furthermore, an updated meta-analysis should include 11 new randomized trials on treadmill training after 2009. Physiotherapy-led treadmill training can easily be transferred in to the German healthcare context since the environmental and educational preconditions are met by German physiotherapeutic care.

Implication for research: Within the German context, there is need to prepare a randomised clinical trial evaluating the impact of physiotherapy-led treadmill training on motor functioning, quality of life, costs, adverse events and long-term effects. Prior to this, a feasibility study should explore the acceptance and intensity of treadmill training as well as the access of private physiotherapy practices to people suffering from early- to mid-stage Parkinson’s disease.

Schlüsselwörter

Morbus Parkinson - Physiotherapie - Laufbandtherapie - Wissenstransfer

Key words

Parkinson’s disease - physical therapy - treadmill training - technology transfer
 

  • Literatur

  • 1 Almeida Q, Bhatt H. A Manipulation of Visual Feedback during Gait Training in Parkinson’s Disease. Parkinsons Dis 2012; DOI: 10.1155/2012/508720 508720.
    PubMedGoogle Scholar
  • 2 Bundesgesetzblatt Online. Gesetz zur Einführung einer Modellklausel in die Berufsgesetze der Hebammen, Logopäden, Physiotherapeuten und Ergotherapeuten; vom 25. September 2009. Jahrgang 2009 Teil I Nr. 64. www.bgbl.de/banzxaver/bgbl/start.xav?start=%2F%2F*[%40attr_id%3D%27bgbl109s3158.pdf%27]#__bgbl__%2F%2F*[%40attr_id%3D%27bgbl109s3158.pdf%27]__1429360693569 (02.04.2015)
    PubMedGoogle Scholar
  • 3 Canning C, Allen N, Dean C et al. Home-based treadmill training for individuals with Parkinson’s disease: a randomized controlled pilot trial. Clin Rehabil 2012; 26: 817-826
    CrossrefPubMedGoogle Scholar
  • 4 Chaiwanichsiri D, Wangno W, Kitisomprayoonkul W et al. Treadmill training with music cueing: a new approach for Parkinson’s gait facilitation. Asian Biomed 2011; 5: 649-654
    PubMedGoogle Scholar
  • 5 Chalkidou K, Tunis S, Whicher D et al. The role for pragmatic randomized controlled trials (pRCTs) in comparative effectiveness research. Clin Trials 2012; 9: 436-446
    CrossrefPubMedGoogle Scholar
  • 6 Der Heilmittelkatalog. 2011 heilmittelkatalog.de/heilmittelkatalog-online.html (22.08.2013)
    PubMedGoogle Scholar
  • 7 Eggert K, Oertel W, Reichmann H. Leitlinien: Parkinson-Syndrome – Diagnostik und Therapie. AWMF online. 2012. www.awmf.org/leitlinien/detail/ll/030-010.html (22.08.2013)
    PubMedGoogle Scholar
  • 8 Ehret R, Balzer-Geldsetzer M, Reese JP et al. Direct costs for Parkinson’s treatment in private neurology practices in Berlin. Der Nervenarzt 2009; 80: 452-458
    CrossrefPubMedGoogle Scholar
  • 9 Ewers M, Grewe T, Höppner H et al. Forschung in den Gesundheitsfachberufen – Potenziale für eine bedarfsgerechte Gesundheitsversorgung in Deutschland. Dtsch Med Wochenschr 2012; 137: 37-73
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Frazzitta G, Maestri R, Uccellini D et al. Rehabilitation treatment of gait in patients with Parkinson’s disease with freezing: a comparison between two physical therapy protocols using visual and auditory cues with or without treadmill training. Movement Disorders 2009; 24: 1139-1143
    CrossrefPubMedGoogle Scholar
  • 11 Frazzitta G, Balbi P, Maestri R et al. The beneficial role of intensive exercise on Parkinson disease progression. American Journal of Physical Medicine & Rehabilitation/Association of Academic Physiatrists 2013; 92: 523-532
    CrossrefPubMedGoogle Scholar
  • 12 Ganesan M, Pal PK, Gupta A et al. Effect of partial weight supported treadmill gait training on balance in patients of Parkinson’s disease [abstract]. Parkinsonism Relat Disord 2010; 16 (Suppl. 01) S66
    PubMedGoogle Scholar
  • 13 Ganesan M, Sathyaprabha TN, Gupta A et al. Effect of Partial Weight-Supported Treadmill Gait Training on Balance in Patients with Parkinson Disease. PM&R: The Journal of Injury, Function, and Rehabilitation 2014; 6: 22-33
    PubMedGoogle Scholar
  • 14 Herman T, Giladi N, Gruendlinger L et al. Six weeks of intensive treadmill training improves gait and quality of life in patients with Parkinson’s disease: a pilot study. Archives of Physical Medicine and Rehabilitation 2007; 88: 1154-1158
    CrossrefPubMedGoogle Scholar
  • 15 Herman T, Giladi N, Hausdorff JM. Treadmill training for the treatment of gait disturbances in people with Parkinson’s disease: a mini-review. Journal of Neural Transmission 2009; 116: 307-318
    CrossrefPubMedGoogle Scholar
  • 16 Hirtz D, Thurman DJ, Gwinn-Hardy K et al. How common are the “common” neurologic disorders?. Neurology 2007; 68: 326-337
    CrossrefPubMedGoogle Scholar
  • 17 Hoehn MM, Yahr MD. Parkinsonism: onset, progression and mortality. Neurology 1967; 17: 427-442
    CrossrefPubMedGoogle Scholar
  • 18 Keller S, Kessler T, Meuser T et al. Analysis of direct costs in therapy of Parkinson disease. Der Nervenarzt 2003; 74: 1105-1109
    CrossrefPubMedGoogle Scholar
  • 19 Kleiner-Fisman G, Gryfe P, Naglie G. A Patient-Based Needs Assessment for Living Well with Parkinson Disease: Implementation via Nominal Group Technique. Parkinson’s Disease 2013; 974964
    PubMedGoogle Scholar
  • 20 Medizinischer Dienst der Krankenversicherung Baden-Württemberg (MDK). Verordnungsreport 2013 www.mdkbw.de/docs/Verordnungsreport BW 2013.pdf (22.08.2013)
    PubMedGoogle Scholar
  • 21 Mehrholz J, Friis R, Kugler J et al. Treadmill training for patients with Parkinson’s disease. The Cochrane Database of Systematic Reviews 2010; CD007830
    PubMedGoogle Scholar
  • 22 Miyai I, Fujimoto Y, Yamamoto H et al. Long-term effect of body weight-supported treadmill training in Parkinson’s disease: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation 2002; 83: 1370-1373
    CrossrefPubMedGoogle Scholar
  • 23 Murad MH, Montori VM, Ioannidis JP et al. How to read a systematic review and meta-analysis and apply the results to patient care: users’ guides to the medical literature. JAMA 2014; 312: 171-179
    CrossrefPubMedGoogle Scholar
  • 24 Nadeau A, Pourcher E, Corbeil P. Effects of 24 Weeks of Treadmill Training on Gait Performance in Parkinson Disease. Med Sci Sports Exerc 2014; 46: 645-655
    CrossrefPubMedGoogle Scholar
  • 25 Nadeau A, Pourcher E, Corbeil P. Effects of 24 Weeks of Treadmill Training on Gait Performance in Parkinson Disease. Medicine and science in sports and exercise. 2013; DOI: 10.1249/MSS.0000000000000144.
    PubMedGoogle Scholar
  • 26 Nijkrake MJ, Keus SHJ, Overeem S et al. The ParkinsonNet concept: development, implementation and initial experience. Movement disorders : official journal of the Movement Disorder Society 2010; 25: 823-829
    PubMedGoogle Scholar
  • 27 Nisenzon AN, Robinson ME, Bowers D et al. Measurement of patient-centered outcomes in Parkinson’s disease: what do patients really want from their treatment?. Parkinsonism & Related Disorders 2011; 17: 89-94
    CrossrefPubMedGoogle Scholar
  • 28 Picelli A, Melotti C, Origano F et al. Does robotic gait training improve balance in Parkinson’s disease? A randomized controlled trial. Parkinsonism Relat Disord 2012; 18: 990-993
    CrossrefPubMedGoogle Scholar
  • 29 Picelli A, Melotti C, Origano F et al. Robot-assisted gait training in patients with Parkinson disease: a randomized controlled trial. Neurorehabil Neural Repair 2012; 26: 353-361
    CrossrefPubMedGoogle Scholar
  • 30 Rios LP, Ye C, Thabane L. Association between framing of the research question using the PICOT format and reporting quality of randomized controlled trials. BMC Med Res Methodol 2010; 10: 11
    CrossrefPubMedGoogle Scholar
  • 31 Rose MH, Løkkegaard A, Sonne-Holm S et al. Improved clinical status, quality of life, and walking capacity in Parkinson’ss disease after body weight-supported high-intensity locomotor training. Arch Phys Med Rehabil 2013; 94: 687-692
    CrossrefPubMedGoogle Scholar
  • 32 Shankar A, Labelle N, Derwent L et al. Treadmill-walking with music shows a synergistic improvement in gait and balance in patients with Parkinson’s disease: a randomized controlled trial [abstract]. Mov Disord 2009; 24 (Suppl. 01) S281-S282
    PubMedGoogle Scholar
  • 33 Shulman LM, Katzel LI, Ivey FM et al. Randomized Clinical Trial of 3 Types of Physical Exercise for Patients with Parkinson Disease. JAMA Neurol 2013; 70: 183-190
    CrossrefPubMedGoogle Scholar
  • 34 Spottke AE, Reuter M, Machat O et al. Cost of Illness and its Predictors for Parkinson’s Disease in Germany. PharmacoEconomics 2005; 23: 817-836
    CrossrefPubMedGoogle Scholar
  • 35 Statistisches Bundesamt. Das Informationssystem der Gesundheitsberichterstattung des Bundes. 2013 www.gbe-bund.de/gbe10 / pkg_isgbe5.prc_isgbe?p_uid=gast&p_aid=48962022&p_sprache=D (22.08.2013)
    PubMedGoogle Scholar
  • 36 The Royal Dutch Society for Physical Therapy (KNGF). KNGF Guidelines for Physical Therapy in Patients with Parkinson’s Disease. Supplement to the Dutch Journal of Physical Therapy 2004; 114
    PubMedGoogle Scholar
  • 37 Tomlinson CL, Patel S, Meek C et al. Physiotherapy versus placebo or no intervention in Parkinson’s disease. The Cochrane Database of Systematic Reviews 2012; CD002817
    PubMedGoogle Scholar
  • 38 Voigt-Radloff S, Stemmer R, Behrens J et al. Forschung zu komplexen Interventionen in der Pflege- und Hebammenwissenschaft und in den Wissenschaften der Physiotherapie, Ergotherapie und Logopädie. 2013 www.cochrane.de/sites/cochrane.de/files/uploads/GFB_Leitfaden.pdf (19.08.2014)
    PubMedGoogle Scholar
  • 39 Voigt-Radloff S, Lang B, Antes G. Einführung: Forschungs- und Innovationspotenziale in den Gesundheitsfachberufen. ZEFQ 2014; 108 (Suppl. 01) S4-S8
    PubMedGoogle Scholar
  • 40 Wissenschaftliches Institut der AOK. Heilmittelbericht. 2013 www.wido.de (22.08.2013)
    PubMedGoogle Scholar
  • 41 Wissenschaftsrat. Empfehlungen zu hochschulischen Qualifikationen für das Gesundheitswesen. 2012 (02.04.2015) www.wissenschaftsrat.de/download/archiv/2411-12.pdf
    PubMedGoogle Scholar
  • 42 Wolters EC. Non-motor extranigral signs and symptoms in Parkinson’s disease. Parkinsonism Related Disorders 2009; 15: 6-12
    CrossrefPubMedGoogle Scholar