StepuP: Steps Against the Burden of Parkinson's Disease
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 42
- 试验地点
- 2
- 主要终点
- Gait speed
研究概览
简要总结
Parkinson's Disease Treadmill Training RCT Summary
Parkinson's disease (PD) affects over 10 million people globally. Despite optimal pharmacological treatment, approximately 70% of individuals experience unstable gait and falls, leading to loss of confidence, social isolation, fractures, and frequent hospitalisations. Treadmill training-especially when augmented by mechanical or virtual-reality perturbations-has shown promise in improving gait and reducing fall risk. However, the mechanisms underlying these benefits remain poorly understood, limiting the ability to personalise interventions effectively.
This randomised controlled trial (RCT) forms part of the broader Steps Against the Burden of Parkinson's Disease project (CT-IDs: 6ef2e427b002, 6ef2e427b003, 6ef2e427b004), comprising three harmonised but independently conducted RCTs. All sites follow a shared core protocol, allowing for pooled data analysis while preserving site-specific perturbation adaptations. Findings from this trial will be reported both independently and as part of the combined dataset.
In this trial, participants with PD will undergo 12 sessions of treadmill training, with or without virtual reality and perturbation-based adaptations. Assessments will be conducted at baseline, post-training, and follow-up. The intervention aims to enhance gait through improved sensorimotor integration and balance control. During the follow-up period, a smartphoneapp "Walking Tall" will be used to encourage continued exercises and long-term retention of training effects.
Biomechanical analyses will focus on changes in foot placement control. Neurophysiological outcomes will be examined using EEG and EMG, targeting reductions in beta-band EEG power and enhanced EEG-EMG coherence as markers of improved gait stability.
Recognising that laboratory-based improvements may not always translate to daily life, this study will also investigate gait self-efficacy as a potential moderator of transfer. Remote monitoring tools will capture real-world mobility outcomes over a week. Machine learning techniques will be employed to identify factors differentiating those who improve in both settings from those who do not. These insights will inform the development of personalised interventions capable of translating training effects into meaningful real-life outcomes.
详细描述
i. Rationale The rationale of this trial is that speed-dependent treadmill training (SDTT) improves gait in people with Parkinson's disease (PD) through enhanced sensorimotor integration, with cortical activity changes as underlying neural correlates. Additional benefits may be gained when treadmill training includes perturbations, which help train reactive balance responses. Furthermore, it is hypothesised that improvements in gait quality through SDTT can enhance gait self-efficacy, which may mediate or moderate the transfer of training effects to everyday mobility. Understanding these mechanisms is essential for personalising interventions and maximising real-world outcomes.
ii. Objectives
The objectives of the StepuP project are to:
- Understand the kinematic and neural mechanisms that underlie improvements in gait due to treadmill training with and without mechanically and VR-triggered gait adaptations in people with PD.
- Assess the extent to which gait improvements measured in the laboratory transfer to improvements in daily-life mobility.
- Identify the mechanisms that support or limit the transfer of training effects from lab-based gait improvements to real-world mobility.
- Determine for whom treadmill training improves gait characteristics in the lab and for whom it does not, and similarly, who benefits in terms of daily-life mobility.
Achieving these objectives will advance understanding of the variability in individual response to treadmill training, allowing more targeted and ultimately personalised interventions to improve outcomes in PD.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Basic Science
- 盲法
- Double (Investigator, Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Diagnosis of PD according to the MDS Criteria
- •Hoehn and Yahr stages I to III;
- •Movement Disorder Society-sponsored version of the Unified Parkinson Disease Rating Scale (MDS-UPDRS) gait sub-score of 1 or more
- •Signed informed consent to participation
排除标准
- •Any known general health condition likely to interfere with or to pose a contraindication to non-medically supervised physical exercise.
- •Moderate or severe depression (BDI-II ≥18)
- •Cognitive impairment which may preclude the possibility to provide a fully informed consent to enrolment.
- •Linguistic comprehension capacity less than 75% in ordinary conversation
- •Severe psychiatric comorbidity which may interfere with compliance to the study protocol
- •History of or current status of substance dependency
- •Unable to walk less than 1 floor
- •Thoracic pain in the last 4 weeks
- •Currently enrolled in other interventional studies
- •Implanted Deep Brain Stimulation device
结局指标
主要结局
Gait speed
时间窗: Baseline (week 1), Post-Training (week 14), Follow-up (week 26)
Comfortable walking speed overground
次要结局
- EuroQol 5-Dimension (EQ-5D) Questionnaire(Baseline (week 1), Post-Training (week 14), Follow-up (week 26).)
- Fall Events(Retrospective report at Baseline (week 1); ongoing reporting through Follow-up (week 26).)
- Modified Gait Efficacy Scale (mGES)(Baseline (week 1), Post-Training (week 14), Follow-up (week 26).)
- Montreal Cognitive Assessment (MoCA)(Baseline (week 1), Follow-up (week 26).)
- New Freezing of Gait Questionnaire (NFOGQ)(Baseline (week 1), Post-Training (week 14), Follow-up (week 26).)
- Daily Step Count(Baseline (week 1), Post-Training (week 14), Follow-up (week 26).)
- Stride Time Variability(Baseline (week 1), Post-Training (week 14), Follow-up (week 26).)
- FACIT Fatigue Scale (Functional Assessment of Chronic Illness Therapy - Fatigue)(Baseline (week 1), Post-Training (week 14), Follow-up (week 26).)
- Timed Up and Go (TUG)(Baseline (week 1), Post-Training (week 14), Follow-up (week 26).)
- Mini-BESTest(Baseline (week 1), Post-Training (week 14), Follow-up (week 26).)
- Uninterrupted Walking Duration(Baseline (week 1), Post-Training (week 14), Follow-up (week 26).)
- Frailty Index (FI)(Baseline (week 1), Post-Training (week 14), Follow-up (week 26).)
- Foot placement kinematics(Baseline (week 1), Post-Training (week 14), Follow-up (week 26).)
- Two-Minute Walk Test (2MWT)(Baseline (week 1), Post-Training (week 14), Follow-up (week 26).)
- Visual Analogue Scale (VAS)(Baseline (week 1), Post-Training (week 14), Follow-up (week 26).)
- Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS Part III)(Baseline (week 1), Post-Training (week 14), Follow-up (week 26).)
- System Usability Scale (SUS)(Post-Training (week 14), Follow-up (week 26).)
- Beta band activity(Baseline (week 1), Post-Training (week 14), Follow-up (week 26).)
- Short Falls Efficacy Scale International (Short FES-I)(Baseline (week 1), Post-Training (week 14), Follow-up (week 26).)
- Color Trail Test (CTT)(Baseline (week 1), Follow-up (week 26).)
- Gait Symmetry(Baseline (week 1), Post-Training (week 14), Follow-up (week 26).)
- EEG-EMG coherency in the beta band(Baseline (week 1), Post-Training (week 14), Follow-up (week 26).)
- Physical Activity Enjoyment Scale (PACES)(Post-Training (week 14), Follow-up (week 26).)
- Attitudes Towards Physical Activity(Post-Training (week 14), Follow-up (week 26).)
- Participant experience(Post-Training (week 14), Follow-up (week 26).)
研究者
Yoshiro Okubo
Conjoint Senior Lecturer
The University of New South Wales