Dados do Trabalho

Título

Vestibular rehabilitation on postural balance and instability in patients with Parkinson´s disease: a systematic review

Resumo

Background: Instability and postural imbalance impair the quality of life of Parkinson's disease patients (PD). Previous studies already described vestibular system connections to these functions, suggesting involvement of vestibular nuclei, the vestibulo-espinhal lateral system, and the participation of basal ganglia in the reception of vestibular stimuli. We hypothesize that vestibular rehabilitation may contribute to the treatment of PD through central neuroplasticity mechanisms such as adaptation, habituation, and substitution. Objective: Investigate the efficacy of vestibular rehabilitation in postural instability and balance in patients with DP, in comparison to other routine interventions or care, using randomised clinical trials. Methods: The electronic data bases used were PubMed/Medline, Embase, Scopus, and the Physical Therapy Evidence Database (PEDro). The system review was registered in PROSPERO with the ID CRD42020210185, in accordance with PRISMA recommendations. The first stage of data extraction was carried out independently by two revisors, with any discrepancies being resolved by a third. The studies included had no restrictions on publication dates or languages, and the most recent update occurred in October of 2021. Results: 109 of the 440 searches were duplicated, and 303 were removed after reading the title and summary, leaving 28 candidates for full text reading. Twenty of these were excluded due to discordance, and four were annotated by a third reviewer due to discrepancies, leaving four studies for systemic review. One study was conducted in Turkey, one in Ireland, and two in Italy; the Hoehn and Yahr scale ranged from 1 to 4, and the average PD duration ranged from 3.3 to 10.3 years. Interventions occurred in all studies in the clinical state "on." The frequency of interventions ranged from one to three times per week, for a total of six years and eight weeks, with each session lasting 40 to 60 minutes. The Berg Balance Scale was described in all the studies, the Activities-Specific Balance Confidence scale and the Dynamic Gait Index in two of them, and the others had only one description. The majority of the outcomes in the four systemic review studies showed statistically significant improvements in postural stability and balance after vestibular rehabilitation. Conclusion: Vestibular rehabilitation is another type of therapy that can help patients with DP improve their balance and stability.