A Rehabilitative Approach in Patients With Parkinson's Disease

Study Overview
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Brief Summary
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The purpose of the study is to evaluate the effectiveness of a rehabilitative approach using breathing and relaxation techniques, and specifically the elongation of the latissimus dorsi muscle according to the Mézières Method to improve balance and posture and relief pain in patients with Parkinson's disease.

Official Title
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Impact of Mézières Rehabilitative Method in Patients With Parkinson's Disease: a Randomized Controlled Trial

Conditions
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Parkinson's Disease

Intervention / Treatment
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* Other: Mézières Method
* Other: Home based exercise program


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosis od idiopathic Parkinson's disease (according to UK Brain Bank Criteria), Hoehn-Yahr stage ≤3 (determined during on phase), Mini Mental State Examination (MMSE) > or = 27, no rehabilitation treatment carried out within 3 months prior to the study, diagnosis of Parkinson's disease by at least 5 years. Exclusion Criteria: Dyskinesias Severe fluctuations on-off Modifications of anti-Parkinsonian drug therapy during the three months prior to the start of the study) Sensitivity deficit of the trunk or lower extremities (physical examination) Vestibular disorders or paroxysmal vertigo Previous thoracic or abdominal surgery Other neurological or orthopedic conditions involving the trunk or lower extremities (musculoskeletal diseases, severe osteoarthritis, peripheral neuropathy, prosthetic surgery) Cardiovascular comorbidities (recent myocardial infarction, heart failure, uncontrolled hypertension, orthostatic hypotension)

Ages Eligible for Study
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Minimum Age: 40 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Mézières Method group<br>Sessions of exercises for the recovery of midline symmetry, diaphragmatic breathing exercises, stretching of the latissimus dorsi respecting the global elongation according to the Mézières Method. | Other: Mézières Method<br>* 10 sessions of rehabilitative treatment according to the Mézières Method, 2 sessions per week for 5 weeks, each lasting 1 hour.<br>|
| Active Comparator: Home based exercise program group<br>Sessions of home based exercises performed by the patients at their domicile after a training session about the exercise program made by a physiotherapy. The exercises aimed at promoting trunk control in static and dynamic position according to the specific guidelines for Parkinson's disease and proprioceptive exercises for the recovery of balance. An illustrated exercises booklet was given to the patient. | Other: Home based exercise program<br>* 1 single training session lasting 1 hour for the explication of the rehabilitation program that the patient has to perform independently at home followed by 2 sessions of home based exercises per week for 5 weeks, each lasting 1 hour.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change of Berg Balance Scale (BBS) from baseline to 12 weeks | It is a widely used clinical tests to evaluate static and dynamic balance of a subject. The total score is 56 (> 45 safe walking without aids/low tendency to fall, > 35 safe walking with aids). The test lasts 15-20 minutes, and includes 14 simple tasks. The success in achieving each task is evaluated assigned a score from zero (dependent) to four (independent), and the final measure is the sum of all scores. The scale is considered the gold standard for providing useful information on the predictive estimation of the risk of falls. | Baseline, 4 weeks, 12 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change of Visual Analogue Scale (VAS) from baseline to 12 weeks | It is a scale for the assessment of pain and it's based on a ten point scale, where 0 means no pain and 10 the greatest pain ever both at rest and during movements. | Baseline, 4 weeks, 12 weeks | 
| Change of Unified Parkinson's Disease Rating Scale (UPDRS) from baseline to 12 weeks | It consists of six parts made up of questions about the mental state, behavior and mood, ADL, motor functions, the complications of the advanced disease, the stage of the disease identified by the Hoehen and Yahr scale and the modification in the execution of the ADL trough the scale of Schwab and England. The scale is based on a metric scale from 0 (no disability) to 147 points (severe disability). | Baseline, 4 weeks, 12 weeks | 
| Change of Functional Gait Assessment (FGA) from baseline to 12 weeks | It is a 10-items scale that measures walking balance activity and it was developed from the Dynamic Gait Index (DGI) to improve reliability and decrease the ceiling effect. Each item is scored on a 3 point-scale from 0 (severe impairment) to 3 (normal deambulation). The highest possible score is 30 (normal gait function). | Baseline, 4 weeks, 12 weeks | 
| Change of Clinical Evaluation of Posture from baseline to 12 weeks | It is the evaluation of the anterior flexion of the trunk by measuring the distance fingers-floor. | Baseline, 4 weeks, 12 weeks | 
| Change of Modified Parkinson Activity Scale (MPAS) from baseline to 12 weeks | consists of 14 items arranged into three domains, chair transfer, gait akinesia and bed mobility. Scores range from 0 (dependent) to 4 (normal) and the total possible score is 56. | Baseline, 4 weeks, 12 weeks | 
| Change of SF-36 Health Survey Questionnaire from baseline to 12 weeks | It is a multi-dimensional questionnaire for the evaluation of health status. It is divided into eight sub-categories that measure physical activity, limitations due to physical health and emotional state, physical pain, the perception of general health, vitality, social activities, mental health and changes in health status and two indices that summarize the overall assessment of the subject with respect to his/her physical (ISF) and mental (ISM) health. | Baseline, 4 weeks, 12 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Posture, Pain, Muscle stretching, Mézières method, Camptocormia, Trunk control