Cueing training in the home improves gait-related mobility in Parkinson's disease: The RESCUE trial

A. Nieuwboer, G. Kwakkel, L. Rochester, D. Jones, E. Van Wegen, A. M. Willems, F. Chavret, V. Hetherington, K. Baker, I. Lim

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Abstract

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.

Original languageEnglish
Pages (from-to)134-140
Number of pages7
JournalJournal of Neurology, Neurosurgery and Psychiatry
Volume78
Issue number2
DOIs
Publication statusPublished - Feb 2007

Keywords

  • Aged
  • Aged, 80 and over
  • Caregivers
  • Cross-Over Studies
  • Exercise Therapy
  • Female
  • Gait Disorders, Neurologic/etiology
  • Humans
  • Male
  • Middle Aged
  • Outpatients
  • Parkinson Disease/complications
  • Postural Balance
  • Quality of Life
  • Single-Blind Method
  • Treatment Outcome

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