早期团体康复运动改善帕金森病患者的生活质量探讨

Early implementation of group rehabilitation exercisei mi proves quality of life in patientsswith Parkinson's disease

目的探讨早期团体特异性运动康复对PD患者的运动和非运动症状的影响。方法收集我院门诊及住院的88例PD患者, 采用随机延迟设计方案, 将患者随机分为早期团体运动组(E-EG)、延迟运动组(L-EG)以及对照组(CG)。E-EG执行严格正规的团体特异性运动康复方案, 2次/周, 1 h/次, 持续18个月(2018年5月至2019年11月);L-EG参加上述运动方案的最后6~12个月训练。本研究应用PD统一的疾病评分量表(UPDRS)、生活质量问卷(PDQ-39)、连线A、连线B测试、九孔柱测试、30 s蹲起试验(30s SST)、10 m步速、运动平衡评估系统(Mini-BEST)、高级平衡量表(FAB)及简易平衡量表(TUG)评估。结果 E-EG组的PD患者训练后UPDRS均值17.5±8.3较训练前UPDRS均值20.0±8.6明显下降(t=-2.2, P=0.02), 训练后PDQ-39评分均值27.2±2.1较训练前PDQ-39评分均值29.0±9.8显著下降(t=-2.6, P=0.001), 训练后连线B均值114.2±25.5较训练前均值129.8±28.4明显减少(t=-2.3, P=0.02)以及训练后9孔柱试验均值33.7±7.3较训练前均值39.6±9.3显著下降(t=-2.5, P=0.001)。结论团体特异性运动康复训练的实施改善了PD患者的运动能力和生活质量, 尤其在早期运动组。特异性运动康复应尽早应用于PD的综合治疗策略当中, 让更多的PD患者受益。

Objective To investigate the impact of group-based rehabilitation exercise on motor and non-movement symptoms of Parkinson's disease(PD).Methods A total of 88 patients from out-patient and in-patient services at our hospital were randomly assigned to an early exercise group(EEG),a late exercise group(L-EG),and a control group(CG)using a randomized delayed-start design.Patients in the E-EG carried out a rigorous,formal group exercise program,one hour per session,twice per week,for 18 months(May 2018-November 2019).Patients in the L-EG took part in the exercise program in the final 6-12 months of the study.We assessed outcomes using the Unified Parkinson's Disease Rating Scale(UPDRS),Parkinson's disease questionnaire-39(PDQ-39 Q),trailmaking test part A&B,nine-hole peg test(9-HPT),30 second sit to stand test(30s SST),10 m walk test(10 m W),mini-balance evaluation systems test(Mini-BEST),Fullerton Advanced Balance(FAB)Scale and time up and go(TUG)test.Results Compared with pre-exercise levels,patients with PD in the E-EG had lower performance in UPDRS(17.5±8.3 vs.20.0±8.6,t=-2.2,P=0.02)and lower performance in PDQ-39(27.2±2.1 vs.29.0±9.8,t=-2.6,P=0.001)after exercise.Moreover,compared with pre-exercise levels,patients with PD in the E-EG showed decreased post-exercise performance in trail-making test part B(114.2±25.5 vs.129.8±28.4,t=-2.3,P=0.02)and in 9-HPT(33.7±7.3 vs.39.6±9.3,t=-2.6,P=0.001).Conclusions The practice of group-based rehabilitation exercise can improve movement abilities and quality of life in PD patients,especially if implemented early.Targeted rehabilitation exercise should be taken as part of the treatment strategy for PD patients as early as possible to deliver the best benefits.