Feasibility of Music-Assisted Treadmill Training in Parkinson's Disease Patients With and Without Deep Brain Stimulation: Insights From an Ongoing Pilot Randomized Controlled Trial

Abstract

Background: Music-assisted treadmill training (MATT) is a new therapeutic approach for Parkinson's disease (PD) patients, combining treadmill training with rhythmic auditory cueing and visual feedback. PD studies have shown larger positive effects on motor outcomes than usual treadmill training. However, effects on cognition, in contrast, are less clear. Existing studies provided intensive training protocols and included only stable medicated patients. Thus, a pilot randomized controlled trial was designed to analyze the feasibility of a shorter training protocol as well as preliminary effects on cognition, motor function, and patient-centered outcomes in a rehabilitation setting where PD patients with and without deep brain stimulation (DBS) undergo adaptation of medication and DBS settings. Here, we present the results from the feasibility analysis of the still ongoing trial. Methods: Non-demented PD patients with and without DBS were recruited during their inpatient rehabilitation and randomized to an experimental group (EG; 20 min MATT) or an active control group (CG; 20 min bike ergometer training). The trainings took place for 8 consecutive days and were added to the usual rehabilitation. Feasibility was assessed with the following parameters: patients' study protocol acceptance, study protocol transferability into clinical routine, training-induced adverse events, and patients' training perception. Results: Thirty-two patients (EG: n = 15; CG: n = 17; 72% DBS) were included. The study protocol was well-accepted (inclusion rate: 84%). It was transferable into clinical routines; dropout rates of 40% (EG) and 18% (CG) were observed. However, an in-depth analysis of the dropout cohort did not reveal intervention-related dropout reasons. The MATT and the standard ergometer training showed no adverse events and were positively perceived by PD patients with and without DBS. Conclusion: MATT was shown to be a feasible, safe, and enjoyable treatment option in PD patients with and without DBS. Furthermore, the dropout cohort analysis revealed some exciting first insights into possible dropout reasons that go beyond the form of intervention. Therefore, research would benefit from a common practice of dropout analyses, as this would enhance our understanding of patients' therapy adherence and expectations.

Keywords: Parkinson's disease; deep brain stimulation; feasibility; music assisted treadmill; non-pharmacological treatment; randomized controlled trial.

Figure 1

Study protocol.

Figure 2

Summary of patients' flow.

Figure 3

Non-completers' subjective self-perception before and after training compared with the median of completers. (A) Mood before each training for non-completers (C– [1] to C– [7]) compared with the median of completers (C+). (B) Motivation before each training for non-completers (C– [1] to C– [7]) compared with the median of completers (C+). (C) Exhaustion after each training for non-completers (C– [1] to C– [7]) compared with the median of completers (C+). (D) Fun after each training for non-completers (C– [1] to C– [7]) compared with the median of completers (C+).

Figure 4

Patients' subjective self-perception before and after training for the experimental and control group without non-completers. (A) Mood before each training for EG and CG patients. (B) Motivation before each training for EG and CG patients. (C) Exhaustion after each training for EG and CG patients. (D) Fun after each training for EG and CG patients.