Cueing training in the home improves gait-related mobility in Parkinson’s disease: the RESCUE trial
- A Nieuwboer1,*,
- G Kwakkel2,*,
- L Rochester3,*,
- D Jones3,*,
- E van Wegen2,
- A M Willems1,
- F Chavret1,
- V Hetherington3,
- K Baker3,
- I Lim2
- 1Katholieke Universiteit, Leuven, Belgium
- 2Vrije Universiteit Medisch Centrum, Amsterdam, The Netherlands
- 3Northumbria University, Newcastle, UK
- Correspondence to: A Nieuwboer Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Tervuursevest 101, Heverlee 3001, Belgium;
- Received 15 May 2006
- Accepted 17 August 2006
- Revised 2 August 2006
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.
- ADL, activities of daily living
- ICC, intraclass correlation coefficient
- PG score, posture and gait score
- RESCUE, Rehabilitation in Parkinson’s Disease: Strategies for Cueing
- UPDRS, Unified Parkinson’s Disease Rating Scale
↵* These authors contributed equally to this work.
See Editorial Commentary, p 111
Published Online First 22 August 2006
Competing interests: The proceeds of the sale of the CD-Rom will be used to fund completion of analysis of the full RESCUE dataset. We may be involved in this further work.