Discussion
HSP, Parkinson’s disease
HSP, SECONDARY
Move-HSP is the first randomized clinical trial investigating the effects of
gait-adaptability training in people with pure HSP. Our results showed that,
following gait-adaptability training, participants improved on the obstacle subtask
of the E-FAP as well as on various secondary outcome measures of balance and gait.
However, our results did not confirm the hypothesis that adding gait-adaptability
training to usual care would result in greater improvements on these outcome
measures.Previous uncontrolled studies using a pre-post assessment design reported that gait,
balance, and/or gait adaptability performance improved following 3.5 to 10 hours of
C-Mill training in people with Parkinson’s disease,Surprisingly, during the waiting-list period, participants in the control group
improved on the obstacle subtask of the E-FAP as well as on most of the secondary
outcomes, including measures of balance, balance confidence, gait speed, and gait
adaptability. These improvements in the control group may be explained in 2 ways.
First, they may have been influenced by the so-called Hawthorne effect,This study has several strengths and limitations. Despite a delay of 4 months due to
the Covid-19 pandemic, we were able to conduct the trial according to the previously
published protocol.The most important shortcoming of this study was that assessors were not blinded for
group allocation. To limit observational bias, a standardized protocol was used for
all assessments. In addition, the current protocol implemented a relatively short
training period of 5 weeks. Although this is in line with previous
studies,With regard to clinical implications, our study provides insufficient evidence to
conclude that 5 weeks of gait-adaptability training, added to usual care, leads to
greater improvement of gait-adaptability performance in people with HSP compared to
usual care alone. Our study has several implications for future research. Future
studies should focus on the evaluation of long-term gait-adaptability training,
including booster sessions. They should also make use of a validated outcome measure
that is more sensitive than the E-FAP obstacle subtask to the acquisition of complex
gait and dynamic balance skills. Lastly, future studies should include qualitative
assessments of the intervention by patients to improve its feasibility, content and
attractiveness.