Repeated Gait Perturbation Training in Parkinson's Disease and Healthy Older Adults: A Systematic Review and Meta-Analysis

Abstract

Background: Gait impairments are common in healthy older adults (HOA) and people with Parkinson's disease (PwPD), especially when adaptations to the environment are required. Traditional rehabilitation programs do not typically address these adaptive gait demands in contrast to repeated gait perturbation training (RGPT). RGPT is a novel reactive form of gait training with potential for both short and long-term consolidation in HOA and PwPD. The aim of this systematic review with meta-analysis is to determine whether RGPT is more effective than non-RGPT gait training in improving gait and balance in HOA and PwPD in the short and longer term.Methods: This review was conducted according to the PRISMA-guidelines and pre-registered in the PROSPERO database (CRD42020183273). Included studies tested the effects of any form of repeated perturbations during gait in HOA and PwPD on gait speed, step or stride length. Studies using balance scales or sway measures as outcomes were included in a secondary analysis. Effects of randomized controlled trials (RCT) on RGPT were pooled using a meta-analysis of final measures.Results: Of the 4421 studies, eight studies were deemed eligible for review, of which six could be included in the meta-analysis, totaling 209 participants (159 PwPD and 50 HOA). The studies were all of moderate quality. The meta-analysis revealed no significant effects of RGPT over non-RGPT training on gait performance (SMD = 0.16; 95% CI = −0.18, 0.49; Z = 0.92; P = 0.36). Yet, in some individual studies, favorable effects on gait speed, step length and stride length were observed immediately after the intervention as well as after a retention period. Gait variability and asymmetry, signifying more direct outcomes of gait adaptation, also indicated favorable RGPT effects in some individual studies.Conclusion: Despite some promising results, the pooled effects of RGPT on gait and balance were not significantly greater as compared to non-RGPT gait training in PwPD and HOA. However, these findings could have been driven by low statistical power. Therefore, the present review points to the imperative to conduct sufficiently powered RCT's to verify the true effects of RGPT on gait and balance in HOA and PwPD.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php? Identifier: CRD42020183273.

Perturbation-based balance training: Principles, mechanisms and implementation in clinical practice

“…PBT has also been found to improve perturbation recovery measures ( 156 , 159 , 160 , 177 ) and some studies have reported improvements in clinical balance tests such as the Berg Balance Scale in people with Parkinson's disease ( 173 , 174 , 178 ). However, while there appears to be interest in the potential for PBT to improve a broad range of gait and balance measures in clinical populations [see reviews of Hulzinga et al ( 179 ), Coelho et al ( 180 )], as outlined in section What is task-specificity in the context of PBT? and How does PBT differ from other task-specific approaches to fall prevention?, the effects do not necessarily generalize to less-reactive balance and gait measures.…”

The Effectiveness of Perturbation-Based Training in the Treatment of Patients With Stroke: A Systematic Review and Meta-Analysis

“… 21 , 50 This finding was consistent with previous reviews that demonstrated beneficial effects of PBT in fall reduction among young and older healthy adults and individuals with Parkinson’s disease, 18 , 23 , 25 and contrary to the systematic review’s result by Hulzinga et al which found a non-significant improvement in balance when comparing gait perturbation training with non-perturbation training in Parkinson’s disease and healthy older adult. 24 Although PBT showed a favorable effect in balance, 2 included studies showed a non-significant reduction in falling rates over 1-year post-training. 20 , 39 This discrepancy may result from the small sample size that leads to inability to reach sufficient statistical power.…”

“…However, the effect of PBT on balance and balance confidence has not been conclusively determined. In addition, prior reviews focused mainly on the effects of PBT in young and older healthy adults and individuals with Parkinson’s disease, 18 , 23 - 25 there is no review focused on PBT in the treatment of patients with stroke. Therefore, the purpose of this systematic review and meta-analysis was to investigate the effectiveness of perturbation-based training (PBT) on balance and balance confidence in patients with stroke.…”

Perturbation-based Balance Training: Principles, Mechanisms and Implementation in Clinical Practice

“…PBT has also been found to improve perturbation recovery measures (Shimada et al, 2004, Bieryla and Madigan, 2011, Aviles et al, 2019, Pigman et al, 2019 and some studies have reported improvements in clinical balance tests such as the Berg Balance Scale in people with Parkinson's disease (Smania et al, 2010, Shen and Mak, 2015, Wong-Yu and Mak, 2015b). However, while there appears to be interest in the potential for PBT to improve a broad range of gait and balance measures in clinical populations (see reviews of Hulzinga et al (2021), Coelho et al (2022)), as outlined in section 2.2 and 2.3, the effects do not necessarily generalise to less-reactive balance and gait measures. To our knowledge, no current studies in clinical populations have reported non-responders in terms of adaptation of the stability recovery response to PBT.…”