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. 2023 Feb 21;20(5):3806.
doi: 10.3390/ijerph20053806.

Multidisciplinary Intensive Rehabilitation Program for People with Parkinson's Disease: Gaps between the Clinic and Real-World Mobility

Moriya Cohen  1   2 , Talia Herman  1 , Natalie Ganz  1 , Inbal Badichi  2 , Tanya Gurevich  3   4   5 , Jeffrey M Hausdorff  1   4   6   7
Affiliations

Multidisciplinary Intensive Rehabilitation Program for People with Parkinson's Disease: Gaps between the Clinic and Real-World Mobility

Moriya Cohen et al. Int J Environ Res Public Health. .

Abstract

Intensive rehabilitation programs improve motor and non-motor symptoms in people with Parkinson's disease (PD), however, it is not known whether transfer to daily-living walking occurs. The effects of multidisciplinary-intensive-outpatient rehabilitation (MIOR) on gait and balance in the clinic and on everyday walking were examined. Forty-six (46) people with PD were evaluated before and after the intensive program. A 3D accelerometer placed on the lower back measured daily-living walking during the week before and after the intervention. Participants were also stratified into "responders" and "non-responders" based on daily-living-step-counts. After the intervention, gait and balance significantly improved, e.g., MiniBest scores (p < 0.001), dual-task gait speed increased (p = 0.016) and 6-minute walk distance increased (p < 0.001). Many improvements persisted after 3 months. In contrast, daily-living number of steps and gait quality features did not change in response to the intervention (p > 0.1). Only among the "responders", a significant increase in daily-living number of steps was found (p < 0.001). These findings demonstrate that in people with PD improvements in the clinic do not necessarily carry over to daily-living walking. In a select group of people with PD, it is possible to ameliorate daily-living walking quality, potentially also reducing fall risk. Nevertheless, we speculate that self-management in people with PD is relatively poor; therefore, to maintain health and everyday walking abilities, actions such as long-term engaging in physical activity and preserving mobility may be needed.

Keywords: Parkinson’s disease; balance; gait; multidisciplinary rehabilitation; self-management; wearables.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study flowchart of participants at baseline, immediate, and 3 months after completion of the MIOR program.
Figure 2
Figure 2
The average number of daily-living steps post-intervention as compared to pre-intervention in the responders and non-responders. The group of responders (n = 15) increased the daily number of steps by an average of 1602 steps per day after the intervention (in grey); the non-responders (n = 23), in white, reduced the average daily number of steps (p < 0.001). In the responders, one subject was an outlier in the number of daily steps but other basic characteristics were similar to the responder’s group pre intervention. Note that the range for the y-axis differs in the graph for the responders and non-responders.
See this image and copyright information in PMC

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