Parkinson Hastalarında Görev Odaklı Egzersiz ile Kombine Yapılan Miyofasyal Gevşetme Uygulamasının Denge ve Yürüme Üzerine Etkileri

Abstract

This double-blind, randomized controlled trial was designed to evaluate the effects of myofascial release combined with task-oriented circuit training (TOCT) on balance and gait in people with Parkinson's disease (pwPD). The study included 36 participants with Parkinson’s disease (PD), randomized into divided a myofascial release (MG) group (n = 18) and a sham myofascial release (SMG) group (n = 18). Individuals in both groups were treated with TOCT for three days, one hour per session for eight weeks. At the end of each session, 3 sets of 60-second myofascial releases were applied to the posterior neck, thoracic spine, lumbar spine, and thoracolumbar spine using a "foam roller" used in myofascial release. In the MG group, the intensity of the application was performed with a target numerical rating scale of 7/10 in each session, and in the SMG group, the intensity of the application was 0/10 according to the numerical rating scale. Assessments were made by an investigator blinded to application and randomization. Pre- and post-treatment, body structure and function were assessed using the Movement Disorder Society‐sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS), rotation test, cervical, trunk and ankle range of motion (ROM) measurements, and activity assessed with spatiotemporal characteristics of walking, stability limits and postural sway, Berg Balance Scale (BBS), Timed Up and Go Test (TUG), Timed Up and Go Test during Dual Task (TUG-motor and TUG-cognitive) and Trunk Impairment Scale (TIS), and participation assessed using the Parkinson's Disease Questionnaire-8 (PHQ-8) and the Goal Attainment Scale (GAS). The study was completed with 33 subjects. The mean age of the subjects in the MG and SMG groups was 61.83±9.74 and 66.11±8.11 years respectively. As a result of the treatment, all subscores of MDS-UPDRS, in-bed turning time, BBS, TUG, TUG-cognitive, TIS and PHQ-8 scores decreased in both groups, while gait speed, normalised speed, stride length and GAS scores increased (p<0.05). It was found that there was a difference in MDS-UPDRS III, cervical spine extension, lateral flexion, rotation, trunk lateral flexion and rotation, ankle dorsiflexion ROM, walking speed, stride length, normalised speed, percentage of sway phase, percentage of stance phase, lateral stability limits, BBS, TUG, TUG-motor, TUG-cognitive and GAS measurements of the MG group compared to the SMG group after treatment (p<0.05). The present results showed that myofascial release in addition to TOCT had positive effects in reducing motor symptoms associated with PD, increasing stability limits, improving trunk control, increasing ROM, and improving gait and balance in PD. The results suggest that myofascial release can be recommended to patients as an effective adjunct to exercise to enhance the benefits of exercise in PD.