Treadmill training for patients with Parkinson's disease
Abstract
Background
Treadmill training is used in rehabilitation and is described as improving gait parameters of patients with Parkinson's disease.
Objectives
To assess the effectiveness of treadmill training in improving the gait function of patients with Parkinson's disease and the acceptability and safety of this type of therapy.
Search methods
We searched the Cochrane Movement Disorders Group Specialised Register (see Review Group details for more information) (last searched March 2009), Cochrane Central Register of Controlled Trials (The Cochrane Library 2009, Issue 2), MEDLINE (1950 to March 2009), and EMBASE (1980 to March 2009).
We also handsearched relevant conference proceedings, searched trials and research registers, and checked reference lists (last searched March 2009). We contacted trialists, experts and researchers in the field and manufacturers of commercial devices.
Selection criteria
We included randomised controlled trials comparing treadmill training with no treadmill training in patients with Parkinson's disease.
Data collection and analysis
Two review authors independently selected trials for inclusion, assessed trial quality and extracted data. We contacted the trialists for additional information. We analysed the results as standardised mean differences (SMDs) and mean differences (MDs) for continuous variables and relative risk differences (RD) for dichotomous variables.
Main results
We included eight trials (203 participants) in this review. Treadmill training improved gait speed (SMD 0.50; 95% confidence interval (CI) 0.17 to 0.84; P = 0.003; I2 = 0%) (fixed‐effect model), stride length (SMD 0.42; 95% CI 0.00 to 0.84; P = 0.05; I2 = 0%), walking distance (MD = 358 metres; 95% CI 289 to 426; P < 0.0001; I2 = 30%), but cadence did not improve (MD 1.06; 95% CI ‐4.32 to 6.44; P = 0.70; I2 = 0%) at the end of study. Treadmill training did not increase the risk of patients dropping out (RD ‐0.07; 95% CI ‐0.18 to 0.05; P = 0.26; I2 = 51%) (random‐effects model). Adverse events were not reported.
Authors' conclusions
Patients with Parkinson's disease who receive treadmill training are more likely to improve their impaired gait hypokinesia. However, the results must be interpreted with caution because there were variations between the trials in patient characteristics, the duration and amount of training, and types of treatment. Additionally, it is not known how long these improvements may last.
PICOs
Plain language summary
Treadmill training for people with Parkinson's disease
The role of treadmill training for people with Parkinson's disease in improving gait parameters is unclear. Gait hypokinesia is typically one of the primary movement disorders associated with Parkinson's disease. It is an important determinant of disability and quality of life for people with mild to moderate Parkinson?s disease. Treadmill training uses specialised machines to facilitate gait rehabilitation. This review identified eight trials including 203 participants which evaluated this type of therapy. Treadmill training did improve gait speed, stride length and walking distance; cadence did not improve. Acceptability of treadmill training for study participants was good and adverse events were rare.
It is not, however, clear if such devices should be applied in routine rehabilitation or when and how often they should be used.
