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Introduction and Purpose:The most common form of parkinsonism is idiopathic Parkinson’s disease. The cardinal symptoms of idiopathicParkinson’s disease are tremor, rigidity, bradykinesia, posture and gait abnormalities, speech changes, depression, gastrointestinal issues,urinary problems, autonomic features, eye abnormalities, cognitive impairments, cranial nerve dysfunction, and swallowing dysfunction.Abnormalities of posture significantly affect activities of daily living in such patients. Static posturography is used to measure the balanceof an individual during standing. Asingle-blinded controlled trial comparing 4 weeks of outpatient physical therapy with no specific therapyshowed significant improvement in gait in patients with Parkinson’s disease. However, the gains were lost when the patients stoppedexercises at the end of the program. Hence, the authors felt that teaching a simple, implementable home-based exercise could benefitthese patients in improving their balance. Any change in static balance could be measured easily with a force platform.Methodology: A total of 62 clinically diagnosed patients with idiopathic Parkinson’s disease attending a tertiary care centerwere randomized into two groups, one rehabilitation group (those who were taught a simple home-based rehabilitation exerciseprogram on an outpatient basis) and a non-rehabilitation (control) group who were not taught the exercises. They were clinicallyevaluated and their center of pressure (COP) sway area was measured using a computerized static posturography instrument(force platform), at first visit, after 1 month, after 3 months, and after 5 months. The differences in their COP sway area betweenthe visits were compared between the two groups to see the change in postural stability.Results and Discussion: Atotal of 62 patients who satisfied the inclusion criteria were inducted in the study after informed consent. Themean age of the rehabilitation group (n = 32) was 58.66 years and the mean age of the non-rehabilitation group (n = 30) was 59.17 years.69% of the rehabilitation group were males and 31% were females, and in the non-rehabilitation group, 67% were males while 37%were females. The mean duration of disease in the rehabilitation group was 8.31 years and that in the non-rehabilitation group was8.67 years. Most of the variables did not show any significant difference, and hence, the groups were comparable. The baseline meanCOP sway area of the rehabilitation group was 76.53 mm2 and that of the non-rehabilitation group was 76.73 mm2. There was a 11.68%decrease in the COP sway area of the rehabilitation group at the end of the 1st month while the non-rehabilitation group had only 0.22%decrease. At the end of the study, i.e., at 5th month, there was a 32.05% decrease in the sway area from baseline in the rehabilitationgroup, indicating significant improvement in static balance. There was only 1.13% decrease in the sway area of the non-rehabilitationgroup. Both the P values were <0.001, and thus, our study revealed that a simple home-based rehabilitation exercise program taughton an outpatient basis to patients with idiopathic Parkinson’s disease can improve the balance in such patients.Conclusion: There was a statistically significant improvement in the static postural stability of patients with idiopathic Parkinson’sdisease who did exercise at home when compared to those who did not perform the home-based exercises. However, longterm studies need to be done to confirm whether this gain is long lasting.
ABSTRACT
We used a randomized controlled trial and examined the effectiveness of a 3-month, home based, exercise program to the functioning in older Japanese adults. Following the intervention, we also conducted 3- and 6-month follow-up studies of physical functioning and exercise adherence. Participants were older adults (n = 32, 16 males and 16 females, age over 75 years). They were randomly divided into exercise and control groups. The Tokyo Metropolitan Institute of Gerontology Index of Competences, the Mini-Mental State Examinations, as well as physical fitness tests assessing grip strength, maximum step length, 10 m walking speed, and standing on one leg with eyes open were administered to the participants. Moreover, home visit instructions were given biweekly. Participants worked out at home on 3 days a week. Analyses of variance indicated that the intervention group significantly increased their maximum step length and time standing on one leg with eyes open, although there were no significant changes in the other tests. Result of follow-up investigations indicated that maximum step lengths at 3- and 6-months after the intervention were 69.9 and 68.8 cm respectively, which was less than immediately after the intervention (70.6 cm), but significantly higher than before the intervention (65.8 cm). Moreover, the effect of the intervention on standing on one leg with eyes open was maintained at the 6-month follow-up. Furthermore, percentages of participants that exercised more than one day per week 3- and 6 months after the intervention were 87 % and 81 % respectively, which was significantly higher than before the intervention (44 %). These results suggest that the home-based exercise program was effective in promoting adherence for a period of 6-months.
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Introduction @#Home exercise programs are part of home-based rehabilitation or self-management for chronic conditions and are typically unsupervised by health professionals. This paper aimed to identify the most common factors affecting compliance to a home exercise program among patients of a community-based rehabilitation.@*Methods @#This study correlated age, gender, civil status and educational background with perceived factors affecting compliance among patients undergoing community-based rehabilitation. A self-generated questionnaire with a 5-point Likert-type scale was used to measure the patient-related, therapy-related and health care factors affecting compliance. Correlation of the demographic characteristics listed with factors affecting compliance was determined using Person's r and Spearman rho.@*Results @#Around 90-95% of respondents agreed or strongly agreed with the patient-related, therapy-related and health care system factors listed. Correlating with age, pain was a barrier in achieving goals (r=-0.383). Willingness to do exercises had some correlation with doing the home exercises (r=0.366). Pain was a barrier in doing the exercises among married patients (r = -0.485). Willingness to do exercises at home was weakly negatively correlated with a low educational attainment (r = -0.287). All the correlations were not significant.@*Conclusion @#Compliance to a home exercise program are inluenced by the patient's motivation, pain as a barrier in achieving goals, and accommodating staff. Female gender and single status correlated with better compliance but the correlation was not significant.
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ComplianceABSTRACT
Background: Disorders of the musculoskeletal system are common, are responsible for a considerable amount of disability, impairment, and handicap, and are associated with high economic costs. Rehabilitation of chronic musculoskeletal conditions necessitates long-term home-based exercise programs. Exercises have been shown to alleviate pain, improve joint mobility and stability, allow faster return to work and prevent progression of chronic conditions. Non-adherence of patients to unsupervised long-term exercise is a major problem that affects treatment outcome. This study explores Indian physiotherapists’ perception of exercise adherence and their interventions to tackle it in clinical practice. Methods: A convenience sample of fifteen experienced physiotherapists from Saurashtra region of Gujarat was interviewed. Interviews were recorded and analysed. Results: The identified themes revolved around issues of patient-therapist collaboration in chronic rehabilitation. The subordinate themes were: negotiating ownership and self management, education and pain, patient attitudes and communication. Conclusion: Experienced physiotherapists recognised barriers and often critically viewed their practice. They undertook necessary interventions in their practice but persisting non-adherence made them question the patient’s role in the partnership.
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PURPOSE: The purpose of this study was to identify the effects of a home based exercise program for patients with stomach cancer who were undergoing oral chemotherapy. METHODS: The home-based exercise program was developed from the study findings of Winningham (1990) and data from the Korea Athletic Promotion Association (2007). The home-based exercise program consisted of 8 weeks of individual exercise education and exercise adherence strategy. Participants were 24 patients with stomach cancer who were undergoing oral chemotherapy following surgery in 2007 or 2008 at a university hospital in Seoul. Patients were randomly assigned to either the experimental group (11) or control group (13). The effects of the home-based exercise program were measured by level of cancer related fatigue, NK cell ratio, anxiety, and quality of life. Data were analyzed using SPSS/WIN 13.0 version. RESULTS: The degree of cancer related fatigue and anxiety in the experimental group decreased compared to the control group. The NK cell ratio and the degree of quality of life of experimental group increased while that of the control group decreased. CONCLUSION: This study result indicate the importance of exercise and provide empirical evidence for continuation of safe exercise for patients with cancer during their chemotherapy.