Physical therapy and deep brain stimulation in Parkinson's Disease: protocol for a pilot randomized controlled trial

Ryan P Duncan, Linda R Van Dillen, Jane M Garbutt, Gammon M Earhart, Joel S Perlmutter, Ryan P Duncan, Linda R Van Dillen, Jane M Garbutt, Gammon M Earhart, Joel S Perlmutter

Abstract

Background: Subthalamic nucleus deep brain stimulation (STN-DBS) reduces tremor, muscle stiffness, and bradykinesia in people with Parkinson's Disease (PD). Walking speed, known to be reduced in PD, typically improves after surgery; however, other important aspects of gait may not improve. Furthermore, balance may worsen and falls may increase after STN-DBS. Thus, interventions to improve balance and gait could reduce morbidity and improve quality of life following STN-DBS. Physical therapy (PT) effectively improves balance and gait in people with PD, but studies on the effects of PT have not been extended to those treated with STN-DBS. As such, the efficacy, safety, and feasibility of PT in this population remain to be determined. The purpose of this pilot study is to address these unmet needs. We hypothesize that PT designed to target balance and gait impairment will be effective, safe, and feasible in this population.

Methods/design: Participants with PD treated with STN-DBS will be randomly assigned to either a PT or control group. Participants assigned to PT will complete an 8-week, twice-weekly PT program consisting of exercises designed to improve balance and gait. Control group participants will receive the current standard of care following STN-DBS, which does not include prescription of PT. The primary aim is to assess preliminary efficacy of PT on balance (Balance Evaluation Systems Test). A secondary aim is to assess efficacy of PT on gait (GAITRite instrumented walkway). Participants will be assessed OFF medication/OFF stimulation and ON medication/ON stimulation at baseline and at 8 and 12 weeks after baseline. Adverse events will be measured over the duration of the study, and adherence to PT will be measured to determine feasibility.

Discussion: To our knowledge, this will be the first study to explore the preliminary efficacy, safety, and feasibility of PT for individuals with PD with STN-DBS. If the study suggests potential efficacy, then this would justify larger trials to test effectiveness and safety of PT for those with PD with STN-DBS.

Trial registration: NCT03181282 (clinicaltrials.gov). Registered on 7 June 2017.

Keywords: Balance; Deep brain stimulation; Gait; Parkinson’s disease; Physical therapy.

Conflict of interest statement

This study received ethics approval from the Human Research Protection Office at Washington University in St. Louis (IRB ID: 201609148). All participants will provide written, informed consent prior to participation in the study.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Diagram depicting participant recruitment, randomization, assessments, and intervention

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