Effects of disease-specific physiotherapy on functional performance in patients with mild-to-moderate Parkinson’s disease
Date
2023-09-07
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Abstract
Dopamiinergiliste ravimite kõrval kasutatakse Parkinsoni tõvega patsientide sümptomite kontrollimiseks toetava ravimeetodina füsioteraapiat. Füsioterapeutide rolliks Parkinsoni tõvega patsientide ravis on kehalise aktiivsuse soodustamine, motoorsete sümptomite käsitlus ja sekundaarsete komplikatsioonide ennetamine läbi erinevate füsioterapeutiliste sekkumiste kasutamise. On tõendatud mitmete harjutustüüpide positiivne mõju. Siiski ei ole uuringutes tõhusaks osutunud sekkumised füsioterapeudi kliinilises töös sageli rakendatavad, tingituna aja- ja muudest piirangutest, ka on ainult ühele valdkonnale keskenduv sekkumine vastuolus üha olulisemaks muutuva patsiendikeskse füsioteraapia põhimõttega. Napib uuringuid, kus oleks uuritud Parkinsoni tõve füsioteraapia ravijuhendites toodud soovitusi kombineeriva sekkumise mõju.
Doktoritöös uuriti füsioteraapia ravijuhendi põhivaldkondi kombineeriva sekkumise mõju patsientide kõnnile, sealhulgas tardumiste esinemisele, ning enesehinnagulisele igapäevaelu toimetulekupiirangute tasemele. Lisaks analüüsiti füsioterapeudi poolsete instruktsioonide mõju Parkinsoni tõvega patsientide kõnnikiirusele.
Doktoritöö olulisemate tulemustena selgus, et kaheksa nädalane Parkisoni tõve spetsiifiline grupifüsioteraapia parandab patsientide kõnni alustamise kiirust ja proksimaalset liigesliikuvust, vähendab patsientide enesehinnangulist tardumiste ja igapäevaelu toimetulekupiirangute taset. Tulemused viitavad ka Parkinsoni tõvega patsientide kõnni põhjalikuma hindamise olulisusele. Et kõnnikiiruse hindamisele eelnev instruktsioon mõjutab Parkinsoni tõvega isiku kõnnikiirust, on füsioterapeudil on oluline jälgida jagavate instruktsioonide ühtsust. Lisaks peaks kõnni hindamisel arvesse võtma patsiendi sugu, eriti juhul, kui kõnnikiirust ei kohandata kehapikkuse suhtes. Meespatsientide kõnnikiirused ja võimekus kõnni kiirust vajadusel suurenda on suuremad kui naistel.
Doktoritöö suurendab teadlikkust Parkinsoni tõve spetsiifilise füsioteraapia olemusest ja omab praktilist väärtust füsioterapeutidele, kes töötavad Parkinsoni tõvega inimestega. Kokkuvõttes tõestab doktoritöö Parkinsoni tõvega patsientidele suunatud füsioteraapia efektiivsust, rõhutab olulisi aspekte Parkinsoni tõvega patsientide füsioterapeutilisest hindamisest ja loodetavasti tõhustab arstide valmisolekut suunata Parkinsoni tõvega patsiente füsioteraapiasse.
Physiotherapy is used as a supporting treatment alongside dopaminergic drugs to control symptoms of patients with Parkinson’s Disease (PD). The role of a physiotherapist in treatment of patients with PD is to increase the physical activity, handling the motor symptoms and to prevent the secondary symptoms through use of various physiotherapeutic interventions. The positive effect of several types of exercise has been confirmed. However, many of the interventions that have proved effective in studies are not feasible in everyday clinical environment, mainly due to time and other constraints. In addition to this, there is an explicit conflict between the single-domain intervention and the patient-specific physiotherapy principle that is growing in prominence. Studies that investigate and confirm the effects of physiotherapy intervention that also combines the recommendations of physiotherapy guidelines is lacking. In this doctoral study, the effects of a physiotherapeutic intervention combining core areas of physiotherapy guidelines on walking (including the presence of freezing episodes) and self-reported limitations to activities of daily living were studied. In addition to that, the effect of instructions from the physiotherapist on the walking speed of patients with PD was analyzed. As the main outcomes, it can be noted that an 8-week PD-specific group physiotherapy intervention can increase the speed of gait initiation, improve proximal joint mobility, reduce the level of self-reported freezing episodes and limitations to activities of daily living. The results also emphasize the importance of thorough evaluation of gait in patients with PD. As the gait speed is strongly dependent on the instructions given, physiotherapists need to use uniform instructions. In gait assessments, the patients gender needs to be considered, especially if the gait-speed is not controlled for height. Male PD patients not only walk faster due to having a longer stride, but they are also able to increase the speed of walking more when instructed. The study adds to knowledge of the essence of PD-specific physiotherapy and has a practical value to physiotherapists to improve the life of patients with PD. In conclusion, the study emphasizes the efficiency of the disease-specific physiotherapy, highlights the important aspects of physiotherapeutic gait assessment of patients with PD, and anticipates that referral rates to physiotherapy for Estonian patients diagnosed with PD to be promoted
Physiotherapy is used as a supporting treatment alongside dopaminergic drugs to control symptoms of patients with Parkinson’s Disease (PD). The role of a physiotherapist in treatment of patients with PD is to increase the physical activity, handling the motor symptoms and to prevent the secondary symptoms through use of various physiotherapeutic interventions. The positive effect of several types of exercise has been confirmed. However, many of the interventions that have proved effective in studies are not feasible in everyday clinical environment, mainly due to time and other constraints. In addition to this, there is an explicit conflict between the single-domain intervention and the patient-specific physiotherapy principle that is growing in prominence. Studies that investigate and confirm the effects of physiotherapy intervention that also combines the recommendations of physiotherapy guidelines is lacking. In this doctoral study, the effects of a physiotherapeutic intervention combining core areas of physiotherapy guidelines on walking (including the presence of freezing episodes) and self-reported limitations to activities of daily living were studied. In addition to that, the effect of instructions from the physiotherapist on the walking speed of patients with PD was analyzed. As the main outcomes, it can be noted that an 8-week PD-specific group physiotherapy intervention can increase the speed of gait initiation, improve proximal joint mobility, reduce the level of self-reported freezing episodes and limitations to activities of daily living. The results also emphasize the importance of thorough evaluation of gait in patients with PD. As the gait speed is strongly dependent on the instructions given, physiotherapists need to use uniform instructions. In gait assessments, the patients gender needs to be considered, especially if the gait-speed is not controlled for height. Male PD patients not only walk faster due to having a longer stride, but they are also able to increase the speed of walking more when instructed. The study adds to knowledge of the essence of PD-specific physiotherapy and has a practical value to physiotherapists to improve the life of patients with PD. In conclusion, the study emphasizes the efficiency of the disease-specific physiotherapy, highlights the important aspects of physiotherapeutic gait assessment of patients with PD, and anticipates that referral rates to physiotherapy for Estonian patients diagnosed with PD to be promoted
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Keywords
Parkinson disease, physical therapy, effects, gait