Efficacy of Specific Trunk Exercises in the Balance Dysfunction of Patients with Parkinson’s Disease: A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Participant Characteristics
3.2. Variables (Table 3)
3.2.1. Balance
3.2.2. Mobility
3.2.3. Gait
3.2.4. Falls
3.2.5. Motor Status
Author, Year | Mobility/Motor Symptom | Gait | Static and Dynamic Balance |
---|---|---|---|
Vasconcellos [14] 2021 | Movement Disorders Society—Unified Parkinson’s Disease Rating Scale III (MDS-UPDRS-III) observed a reduction of trunk flexion after trunk exercises. | No significant time × group interaction was observed: velocity, hip extension, knee and ankle ROM; with no intragroup differences. | This study failed to find any significant changes in the results of the groups that engaged in exercises at home, unsupervised by a physical therapist. |
Cabrera [16] 2020 | There were no significant differences between groups in MDS-UPDRS-III Scale (p = 0.083). | Significant improvements were found in the anticipatory, reactive postural control, and dynamic gait subscales (p < 0.05). The number of falls in the previous month for the EG significantly decreased (p = 0.047). | The participants in the EG performed significantly better than those in the CG in the dynamic balance assessment (p = 0.002). The EG had a significant improvement in maximal excursion of COP in forward (p = 0.048), right (p = 0.046) and left (p = 0.010) directions of limits of stability. |
Terrens [37] 2020 | They improved the results in both intervention groups (aquatic and land), without being statistically significant, using the UPDRS-III Scale. | They found no significant changes using modified Falls Efficacy Scale. | No significant differences with Berg balance scale among the three groups compared (Halliwick aquatic exercises; traditional aquatic and land physiotherapy). |
Youm [32] 2020 | With Timed Up and Go (TUG) significant results were found (p = 0.004) (intergroup). They evaluated the participants with the Functional Fitness Test (FFT), obtaining favorable results in 2-minute step test (p = 0.044). | With the sit-to-walk test, they obtained improvements in EG in increased length and speed in the first step phase (p = 0.003, p = 0.006, respectively) and during the second step phase in comparison to the CG (p = 0.020 and p = 0.028, respectively). | Significant changes were found for anteroposterior speed (AP) (p = 0.030) and middle lateral (ML) (p = 0.028) of COP trajectory compared with CG |
Gandolfi [33] 2019 | They obtained significant results in both groups before and after the treatment (p = 0.01) but did not find differences between the groups, using the Unified Parkinson’s Disease Rating Scale III. | The number of falls in the previous month for the EG significantly decreased (p = 0.004). | Mini BesTest for dynamic balance obtained significant changes in the EG (p = 0.017). |
Hubble [34] 2019 | They failed to obtain significant differences with Timed Up and Go (TUG). No intervention led to a significant change in mobility, motor symptom severity, or freezing of gait at the 12- or 24-week time points. | Step-by-step gait asymmetry analysis with accelerometer obtained favorable results in the EG in vertical head movements and AP (p = 0.009 and p = 0.011), in trunk AP (p < 0.001), and 12 days following the intervention compared to the initial assessment. | Significant changes were identified in the COP elliptical swing area after 12 weeks of intervention and following 24 weeks (p = 0.029 and p = 0.013 respectively), besides in the ML swing patterns at 12 (p = 0.042) and 24 weeks (p = 0.043). |
Hubble [35] 2018 | They failed to obtain significant differences between groups (education or exercise) with TUG or UPDRS-III. | Trunk-specific exercises may improve (or maintain) step-to step symmetry of trunk movements and trunk muscle function in this population. | No significant differences with ABC scale among the groups. |
Paolucci [38] 2017 | They obtained significant results in the EG (p = 0.002) and CG (p = 0.012) using the 6-minute walk test. They only obtained improvements in the EG using the UPDRS-III (p = 0.007) at 𝑇1. | This study used the Functional gait assessment (FGA) to measure balance during gait, obtaining significant results for the EG, which followed the Mezieres Method (p < 0.001), and the CG (traditional exercises at home) (p = 0.001). | Berg balance scale (BBS), proved to be statistically significant with respect to the CG (without treatment) in favor of the EG (trunk resistance and stretching exercise program), and remaining so following the 12-week evaluation period (p < 0.001). |
Capecci [36] 2014 | All treated patients, independent of treatment group, showed a significant improvement in the trunk posture in both the sagittal and coronal planes, with respect to baseline. | TUG improvements also seem to positively affect functional gait speed (p = 0.028). This benefit is significant when compared with untreated patients. | BBS proved to be statistically significant (p < 0.0001) with respect to the CG (without treatment) in favor of the EG (proprioceptive and tactile stimulation, combined with stretching and postural reeducation). |
3.3. Intervention Characteristics
3.4. Methodological Evaluation
3.5. Meta-Analysis
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Databases and Search Terms | Results | Selected Articles |
---|---|---|
Cochrane Library
| 292 118 22 61 61 | Vasconcellos et al. [14] 2021 Youm et al. [32] 2020 Gandolfi et al. [33] 2019 Hubble et al. [34] 2019 Hubble et al. [35] 2018 Capecci et al. [36] 2014 |
SciELO
| 33 5 1 1 0 | |
PEDro
| 56 24 3 5 14 | Vasconcellos et al. [14] 2021 Youm et al. [32] 2020 Gandolfi et al. [33] 2019 Hubble et al. [34] 2019 Hubble et al. [35] 2018 Paolucci et al. [36] 2017 |
Scopus
| 948 644 30 135 67 | Vasconcellos et al. [14] 2021 Cabrera et al. [16] 2020 Terrens et al. [37] 2020 Youm et al. [32] 2020 Gandolfi et al. [33] 2019 Hubble et al. [34] 2019 Hubble et al. [35] 2018 Paolucci et al. [38] 2017 Capecci et al. [36] 2014 |
PubMed
| 255 411 5 44 20 | Vasconcellos et al. [14] 2021 Cabrera et al. [16] 2020 Terrens et al. [37] 2020 Youm et al. [32] 2020 Gandolfi et al. [33] 2019 Paolucci et al. [38] 2017 Capecci et al. [36] 2014 |
Author, Year | Type of Study and Participants | Characteristics of the Intervention | Measured Variables | Main Results |
---|---|---|---|---|
Vasconcellos [14] 2021 | RCT 28 participants EG: 14 CG: 14 | EG: Trunk exercise program and pelvic floor muscles. CG: Upper and lower limb exercises. Both groups performed home-based exercises under caregiver supervision. Protocol described by Silva and Motta. Duration: 3 times/daily/3 weeks. | Static balance (stabilometry), using a force platform connected to an external amplifier and a motion analysis system. Gait evaluated using the Qualisys® movement analysis system. | No intragroup differences were observed for the COP range (p = 0.353), COP velocity (p = 0.318) or gait measurements (p = 0.778). Trunk-strengthening exercises failed to improve gait and balance compared to limb exercises. A total of 33% failure to complete treatment (9 individuals). The absence of face-to-face therapist supervision may have affected patients’ performance during interventions. |
Cabrera [16] 2020 | RCT 44 participants EG: 22 CG: 22 | EG: 24 sessions core stabilization training program. CG: active joint mobilization, muscle stretching and motor coordination exercises. Duration: 45 min./day, three times/week/8 weeks. | Dynamic balance with Mini-BesTest and standing balance with posturography using the Nintendo Wii (maximal excursion of COP during the Modified Clinical Test of Sensory Interaction on Balance and the Limits of Stability test); Balance confidence (ABC Scale). | A significant improvement in dynamic balance was observed in the EG compared to the CG (p = 0.002); in self-perceived confidence related to balance (p = 0.047); and maximal excursion of COP in forward (p = 0.048), left (p = 0.010), right (p = 0.046) between-group differences. A core stability program may influence anticipatory postural adjustments. |
Terrens [37] 2020 | Pilot Trial 30 participants (G1) 11 (G2) 10 (G3) 9 | (G1) Halliwick aquatic exercises (trunk mobility, core stabilization and rotational exercises); (G2) traditional aquatic and (G3) land-based physiotherapy. Duration: 60 min./week/ 12 weeks. | Balance (BBS and Mini BesTest), Falls (mFES), Motor status (UPDRS-III). | No significant differences within groups were found in UPDRS-III, BBS or mFES scores post-intervention for any groups. Halliwick aquatic group improved significantly in the Mini BesTest post-intervention, i.e., promising results for balance (p = 0.011). |
Youm [32] 2020 | RCT 23 participants EG: 12 CG: 11 | EG: trunk resistance and stretching exercise program. CG: no intervention. Duration: 60–90 min., 3 times/week, 12 weeks. | Trunk mobility scale (TMS test), FFT, TUG, standing balance test with a platform, and sit-to-walk test with Nexus software. | The EG showed improvements in FFT, trunk mobility, standing balance and dynamic stability compared with the CG (all p < 0.05). This 12-week exercise program improved fall-related factors in patients with PD. |
Gandolfi [33] 2019 | RCT 37 participants EG: 19 CG: 18 | EG: Active self-correction exercises (with visual feedback (i.e., mirror), with proprioceptive feedback (EMG feed-back), and without any feedback) + trunk stabilization exercises+ functional tasks (i.e., dual-task exercises). CG: joint mobilization, muscle strengthening and stretching, overground gait-training and balance exercises. Duration: 60 min./5 days/week, 4 weeks. | Forward trunk flexion severity (degree). UPDRS III, dynamic and static balance (Mini BesTest and using an electronic monoaxial platform), pain falls, and quality of life assessment. | The EG reported a significantly greater reduction in forward trunk flexion than the CG from T0 to both T1 (p = 0.003) and T2 (p = 0.004). The improvements in dynamic and static balance were significantly greater for the EG than the CG from T0 to T2 (p = 0.017 and p = 0.004, respectively). The four-week trunk-specific rehabilitation training decreased forward trunk flexion severity and increased postural control. |
Hubble [34] 2019 | RCT 24 participants EG: 13 CG: 11 | EG: exercise (trunk strength, endurance, and mobility) and falls prevention education. CG: weekly pack of printed multidisciplinary education materials: health tips about lifestyle (e.g., exercise) and/or condition-related issues (e.g., poor sleep quality). Duration: 90 min./week, 12 weeks. | Motor symptom severity (UPDRS-III), balance confidence (portable force plate and ABC Scale), mobility (TUG), quality of life (39-item Parkinson Disease Questionnaire) and quiet-standing balance. | No significant changes in clinical outcomes following the intervention. During quiet standing, sway area on a foam surface without vision was reduced for the EG at 12 (p = 0.029) and 24 weeks (p = 0.013). The EG demonstrated reduced sway variability at 12 (p = 0.042) and 24 weeks in the medial–lateral direction (p = 0.043). No changes in quiet standing balance for the CG. |
Hubble [35] 2018 | RCT 24 participants EG: 13 CG: 11 | EG: falls prevention education + exercises: trunk mobility exercises to improve ROM; endurance and stability of the trunk muscles (multifidus, erector spinae, obliques, transverse abdominus, rectus abdominus); and stretching and walking in a real-world environment. CG: multidisciplinary falls prevention education. Duration: 90 min./week, 12 weeks. | Mobility (TUG), walk (gait analysis, accelerometer), falls (ABC scale), motor symptom severity (UPDRS-III). | Statistically significant and clinically relevant improvements in anterior–posterior step-to-step trunk symmetry (p < 0.001) in the EG. CG recorded statistically significant and clinically meaningful reductions in medial–lateral and vertical step-to-step trunk symmetry at 12 weeks (p < 0.001). |
Paolucci [38] 2017 | RCT 36 participants EG: 17 CG: 19 | EG: Mezieres method, 3 postures to correct variations in the dorsal curve, perceive the alignment of trunk and promote diaphragmatic breathing. CG: simple home exercise Duration: 1 h, 2 times/week, 5 weeks, 10 sessions. | Balance (BBS) gait balance (FGA), mobility (SMWT) and disease-related disability (UPDRS-III). | In the Mezieres group, the BBS (p < 0.001) and trunk flexion test (p < 0.001) improved significantly at 𝑇1 and remained the same at 𝑇2. Between groups, significant changes were reported in FGA (p = 0.027) and UPDRS Total (p = 0.007) at 𝑇1 and in FGA (p = 0.03) at 𝑇2. The Mezieres approach is effective in improving the flexibility of the trunk and balance. |
Capecci [36] 2014 | RCT 24 participants EG: 13 CG: 11 | EG: 7 participants, proprioceptive and tactile stimulation, combined with stretching and PR. Six participants had PR as well as Kinesio taping strips applied to their trunk muscles, according to the features of their postural abnormalities CG: No intervention. Duration: 40 min./3 times, 4 weeks, 12 sessions. | Balance (BBS), mobility (TUG) and degrees of trunk bending in the sagittal and coronal planes. | At T1, all treated patients showed a significant improvement in trunk posture in both the sagittal (p = 0.002) and coronal planes (p = 0.01), compared with baseline. Moreover, they showed an improvement in measures of gait and balance (p < 0.01). Benefits persisted at T2 for all measures, except lateral trunk bend. No differences were found when comparing the PR and KT groups. |
Types of Treatments | Other Complementary Exercises | Stretching | Postural Rehabilitation | Central Stabilization | Trunk Strengthening | Trunk Mobility |
---|---|---|---|---|---|---|
Vasconcelos [14] | X | X | ||||
Cabrera [16] | X | |||||
Terrens [37] | Gait and balance | X | X | |||
Youm [32] | X | X | X | |||
Gandolfi [33] | X | X | X | X | X | |
Hubble [34] | Education and self-care preventing falls | X | X | X | ||
Hubble [35] | Education and self-care preventing falls | X | X | X | ||
Paolucci [38] | Respiration | X | X | |||
Capecci [36] | Kinesio taping | X | X | X |
ITEM (PEDro Scale) | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | POINTS |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Vasconcellos [14] 2021 | X | X | X | X | N | N | X | N | X | X | X | 7/10 |
Cabrera [16] 2020 | X | X | X | X | N | N | X | X | X | X | X | 8/10 |
Terrens [37] 2020 | X | X | X | X | N | N | X | N | X | X | X | 7/10 |
Youm [32] 2020 | N | X | N | X | N | N | X | N | N | X | X | 5/10 |
Gandolfi [33] 2019 | N | X | N | X | N | N | X | X | X | X | X | 7/10 |
Hubble [34] 2019 | X | X | N | X | N | N | X | N | N | N | X | 4/10 |
Hubble [35] 2018 | X | X | N | X | N | N | X | X | X | X | X | 7/10 |
Paolucci [38] 2017 | X | X | X | X | N | N | X | X | X | X | X | 8/10 |
Capecci [36] 2014 | N | X | X | X | N | N | X | X | X | X | X | 7/10 |
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López-Liria, R.; Vega-Tirado, S.; Valverde-Martínez, M.Á.; Calvache-Mateo, A.; Martínez-Martínez, A.M.; Rocamora-Pérez, P. Efficacy of Specific Trunk Exercises in the Balance Dysfunction of Patients with Parkinson’s Disease: A Systematic Review and Meta-Analysis. Sensors 2023, 23, 1817. https://doi.org/10.3390/s23041817
López-Liria R, Vega-Tirado S, Valverde-Martínez MÁ, Calvache-Mateo A, Martínez-Martínez AM, Rocamora-Pérez P. Efficacy of Specific Trunk Exercises in the Balance Dysfunction of Patients with Parkinson’s Disease: A Systematic Review and Meta-Analysis. Sensors. 2023; 23(4):1817. https://doi.org/10.3390/s23041817
Chicago/Turabian StyleLópez-Liria, Remedios, Sofía Vega-Tirado, María Ángeles Valverde-Martínez, Andrés Calvache-Mateo, Ana María Martínez-Martínez, and Patricia Rocamora-Pérez. 2023. "Efficacy of Specific Trunk Exercises in the Balance Dysfunction of Patients with Parkinson’s Disease: A Systematic Review and Meta-Analysis" Sensors 23, no. 4: 1817. https://doi.org/10.3390/s23041817