Perturbation During Treadmill Training Improves Dynamic Balance and Gait in Parkinson's Disease: A Single-Blind Randomized Controlled Pilot Trial

Background. Gait and balance dysfunction are major symptoms in Parkinson's disease (PD). Treadmill training improves gait characteristics in this population but does not reflect the dynamic nature of controlling balance during ambulation in everyday life contexts. Objective. To evaluate whether postural perturbations during treadmill walking lead to superior effects on gait and balance performance compared with standard treadmill training. Methods. In this single-blind randomized controlled trial, 43 PD patients (Hoehn & Yahr stage 1-3.5) were assigned to either an 8-week perturbed treadmill intervention (n = 21) or a control group (n = 22) training on the identical treadmill without perturbations. Patients were assessed at baseline, postintervention, and at 3 months' follow-up. Primary endpoints were overground gait speed and balance (Mini-BESTest). Secondary outcomes included fast gait speed, walking capacity (2-Minute Walk Test), dynamic balance (Timed Up-and-Go), static balance (postural sway), and balance confidence (Activities-Specific Balance Confidence [ABC] scale). Results. There were no significant between-group differences in change over time for the primary outcomes. At postintervention, both groups demonstrated similar improvements in overground gait speed (P = .009), and no changes in the Mini-BESTest (P = .641). A significant group-by-time interaction (P = .048) existed for the Timed Up-and-Go, with improved performance only in the perturbation group. In addition, the perturbation but not the control group significantly increased walking capacity (P = .038). Intervention effects were not sustained at follow-up. Conclusions. Our primary findings suggest no superior effect of perturbation training on gait and balance in PD patients. However, some favorable trends existed for secondary gait and dynamic balance parameters, which should be investigated in future trials.