Mobility in atyp. parkinsonism: random.trial of physiotherap

Patients with Parkinson`s disease often show gait impairment and reduced mobility over the disease course. Rare atypical forms of parkinsonism, like multiple system atrophy (MSA) or progressive supranuclear gaze palsy (PSP) develop these features in early disease stages. The reduced mobility and increased time spent in sitting or lying posture leads to loss of physical independence and increased mortality. Since MSA and PSP can currently only be treated symptomatically, a long lasting independence and mobility is therefore of great importance. A positive effect has already been shown in a few studies on specific physiotherapy in patients with idiopathic Parkinson`s disease (IPD), and some small studies also give us an evidence that physiotherapy in atypical parkinsonism can improve mobility. The Mobility_APP study examines the effect of two types of physiotherapy in patients with MSA, PSP and IPD. The participants are initially assigned to a type of therapy and they learn specific exercises with a physiotherapist every day for two weeks. These exercises will then be continued independently at home for another five weeks. Regular checks in the study center ensure a precise examination of the physical condition, quality of life and gait pattern. The latter will be objectively analyzed with the help of sensors that are worn on the participants shoes. In addition, before the start and at the end of the study, the participants are also monitored for one week at home using shoe sensors in order to reflect the natural conditions of the patients. During the entire study, neither the participant nor the study investigator knows what type of therapy is being used in order to guarantee an unbiased analysis (double blinding). The aim of this double-blind, randomized-controlled study is to determine effective physiotherapy in patients with atypical parkinsonian syndromes in order to maintain mobility for as long as possible. If the exercises learned during physiotherapy can be continued regularly at home and can improve mobility, this means a big step towards autonomous therapy. Frequent visits to therapists can be reduced and sufficient and effective independent therapy can still be carried out during times of crisis or phases with increased motor impairment. The project is kindly supported by the Fund for the Promotion of Scientific Research (FWF). Together with the German Research Foundation (DFG) and Swiss National Science Foundation (SNF) in Switzerland this project can be carried out internationally in cooperation with renowned centers for neurological and sensor-based research.

Gait disturbances and impaired mobility are among the most severe and rapidly progressing symptoms in atypical parkinsonian disorders (APD), such as multiple system atrophy and progressive supranuclear palsy. They quickly lead to dependency and a markedly reduced quality of life. In contrast to idiopathic Parkinson's disease (PD), high-quality, evidence-based physiotherapy (PT) guidelines for APS have been lacking so far. The FWF-funded clinical research project Mobility_APP aimed to close this treatment gap by scientifically evaluating, for the first time, the efficacy of a targeted gait-focused physiotherapy (GPT) compared with standard physiotherapy (SPT). In this multicenter, randomized-controlled trial, patients with APD and PD received intensive, individualized physiotherapy during an initial inpatient phase, followed by a self-managed home training program. A key innovation of this study was the use of objective, sensor-based measurement technologies (inertial measurement units, IMUs), which provided highly sensitive indicators of patients' mobility, such as gait speed, stride length, and activity patterns in both daily life and clinical settings-capturing these parameters more precisely than conventional clinical scales. A total of 160 patients were enrolled in the study. The intervention proved to be safe and effective in both study arms. Ultimately, GPT did not demonstrate superiority over SPT in improving self-selected gait speed. However, positive changes in everyday mobility parameters were observed within the GPT group. Moreover, improvements in balance, home mobility, and patients' subjective evaluations were noted in both study arms. In summary, this study represents the first randomized controlled trial providing evidence for the efficacy of physiotherapy in APS. Physiotherapy led to positive trends in gait parameters, clinical scales, and patient-reported outcome measures (PROMs). In particular, GPT appears to further enhance mobility in daily life. Although the primary endpoint was not met, the intervention was safe, well tolerated, and contributed to an objective improvement in functional impairment.