Vertical locomotion improves horizontal locomotion: effects of climbing on gait and other mobility aspects in Parkinson's disease. A secondary analysis from a randomized controlled trial.

BACKGROUND: In the Climb Up! Head Up! trial, we showed that sport climbing reduces bradykinesia, tremor, and rigidity in mildly to moderately affected participants with Parkinson's disease. This secondary analysis aimed to evaluate the effects of sport climbing on gait and functional mobility in this cohort. METHODS: Climb Up! Head Up! was a 1:1 randomized controlled trial. Forty-eight PD participants (Hoehn and Yahr stage 2-3) either participated in a 12-week, 90-min-per-week sport climbing course (intervention group) or were engaged in regular unsupervised physical activity (control group). Relevant outcome measures for this analysis were extracted from six inertial measurement units placed on the extremities, chest, and lower back, that were worn during supervised gait and functional mobility assessments before and after the intervention. Assessments included normal and fast walking, dual-tasking walking, Timed Up and Go test, Instrumented Stand and Walk test, and Five Times Sit to Stand test. RESULTS: Compared to baseline, climbing improved gait speed during normal walking by 0.09 m/s (p = 0.005) and during fast walking by 0.1 m/s. Climbing also reduced the time spent in the stance phase during fast walking by 0.03 s. Climbing improved the walking speed in the 7-m- Timed Up and Go test by 0.1 m/s (p < 0.001) and the turning speed by 0.39 s (p = 0.052), the speed in the Instrumented Stand and Walk test by 0.1 m/s (p < 0.001), and the speed in the Five Times Sit to Stand test by 2.5 s (p = 0.014). There was no effect of sport climbing on gait speed or gait variables during dual-task walking. CONCLUSIONS: Sport climbing improves gait speed during normal and fast walking, as well as functional mobility in people with Parkinson's disease. Trial registration This study was registered within the U.S. National Library of Medicine (No: NCT04569981, date of registration September 30th, 2020).

Robot-assisted surgery in thoracic and visceral indications: an updated systematic review.

BACKGROUND: In surgical advancements, robot-assisted surgery (RAS) holds several promises like shorter hospital stays, reduced complications, and improved technical capabilities over standard care. Despite extensive evidence, the actual patient benefits of RAS remain unclear. Thus, our systematic review aimed to assess the effectiveness and safety of RAS in visceral and thoracic surgery compared to laparoscopic or open surgery. METHODS: We performed a systematic literature search in two databases (Medline via Ovid and The Cochrane Library) in April 2023. The search was restricted to 14 predefined thoracic and visceral procedures and randomized controlled trials (RCTs). Synthesis of data on critical outcomes followed the Grading of Recommendations, Assessment, Development, and Evaluation methodology, and the risk of bias was evaluated using the Cochrane Collaboration's Tool Version 1. RESULTS: For five out of 14 procedures, no evidence could be identified. A total of 20 RCTs and five follow-up publications met the inclusion criteria. Overall, most studies had either not reported or measured patient-relevant endpoints. The majority of outcomes showed comparable results between study groups. However, RAS demonstrated potential advantages in specific endpoints (e.g., blood loss), yet these findings relied on a limited number of low-quality studies. Statistically significant RAS benefits were also noted in some outcomes for certain indications-recurrence, quality of life, transfusions, and hospitalisation. Safety outcomes were improved for patients undergoing robot-assisted gastrectomy, as well as rectal and liver resection. Regarding operation time, results were contradicting. CONCLUSION: In summary, conclusive assertions on RAS superiority are impeded by inconsistent and insufficient low-quality evidence across various outcomes and procedures. While RAS may offer potential advantages in some surgical areas, healthcare decisions should also take into account the limited quality of evidence, financial implications, and environmental factors. Furthermore, considerations should extend to the ergonomic aspects for maintaining a healthy surgical environment.

Climb up! Head up! Climbing improves posture in Parkinson's disease. A secondary analysis from a randomized controlled trial.

OBJECTIVE: To investigate the effect of sport climbing on a biomechanical marker of axial posture in patients with Parkinson's disease, as well as its association with age, body mass index and health-related quality-of-life outcome measures. DESIGN: Pre-planned secondary analysis of our randomized controlled, semi-blind trial (unblinded patients, blinded assessors) comparing sport climbing to unsupervised exercise. SETTING: Single-centre study conducted at the Department of Neurology of the Medical University of Vienna, Austria. PARTICIPANTS: Forty-eight Parkinson's disease patients (aged 64 ± 8 years, Hoehn & Yahr stage 2-3) were included. INTERVENTION: Sport climbers (n = 24) followed a 12-week, 90 min/week supervised top-rope sport climbing course in an indoor climbing gym. The unsupervised training group (n = 24) independently followed the 'European Physiotherapy Guidelines for Parkinson's Disease' and World Health Organization recommendations for an active lifestyle for 12 weeks. MAIN MEASURES: Posture was assessed with the horizontal distance of the seventh cervical vertebra to the wall at baseline and after the intervention. RESULTS: Participating in the sport climbing group significantly predicted the biomechanical marker of axial posture (P = 0.044). The improvement in the biomechanical marker did not affect the quality of life, depression, fatigue, physical activity or fear of falling. Participants in the sport climbing group showed a significantly decreased horizontal distance of the seventh cervical vertebra to the wall after the intervention (-1.7 cm (95%CI [-2.6, -0.8]). In the unsupervised training group, no difference was found (-0.5 cm; 95%CI -1.3, 0.2]). CONCLUSIONS: We conclude that sport climbing improves a biomechanical marker of axial posture in Parkinson's disease.

Additive Effect of Dopaminergic Medication on Gait Under Single and Dual-Tasking Is Greater Than of Deep Brain Stimulation in Advanced Parkinson Disease With Long-Duration Deep Brain Stimulation.

INTRODUCTION: Patients with advanced Parkinson disease (PD) often experience problems with mobility, including walking under single- (ST) and dual-tasking (DT) conditions. The effects of deep brain stimulation in the subthalamic nucleus (DBS) versus dopaminergic medication (Med) on these conditions are not well investigated. MATERIALS AND METHODS: We used two ST and two DT-gait paradigms to evaluate the effect of DBS and dopaminergic medication on gait parameters in 14 PD patients (mean age 66 ± 8 years) under DBSOFF/MedON, DBSON/MedOFF, and DBSON/MedON conditions. They performed standardized 20-meter walks with convenient and fast speed. To test DT capabilities, they performed a checking-boxes and a subtraction task during fast-paced walking. Quantitative gait analysis was performed using a tri-axial accelerometer (Dynaport, McRoberts, The Netherlands). Dual-task costs (DTC) of gait parameters and secondary task performance were compared intraindividually between DBSOFF/MedON vs DBSON/MedON, and DBSON/MedOFF vs DBSON/MedON to estimate responsiveness. RESULTS: Dopaminergic medication increased gait speed and cadence at convenient speed. It increased cadence and decreased number of steps at fast speed, and improved DTC of cadence during the checking boxes and DTC of cadence and number of steps during the subtraction tasks. DBS only improved DTC of cadence during the checking boxes and DTC of gait speed during the subtraction task. CONCLUSION: Dopaminergic medication showed larger additional effects on temporal gait parameters under ST and DT conditions in advanced PD than DBS. These results, after confirmation in independent studies, should be considered in the medical management of advanced PD patients with gait and DT deficits.

Therapeutic climbing in Parkinson's disease: Differences in self-reported health and well-being, feasibility and clinical changes.

BACKGROUND: Therapeutic climbing (TC) is a whole-body workout that stimulates and improves physical and psychosocial abilities. It has been used in neurological rehabilitation, but there is scarce evidence of specific benefits for people with Parkinson's (PwP). OBJECTIVE: To investigate and evaluate self-reported differences in health and well-being among trial participants, the overall feasibility of TC and clinical changes caused as a rehabilitation measure for PwP. METHODS: A 3-level Likert scale survey was completed by 26 PwP (100% response rate) after a TC course (mean 16 sessions) at the Neurological Rehabilitation Center assessing self-perceived differences in health and well-being in terms of physical, psychological, and social parameters. We investigated the feasibility of TC in terms of adherence, practicability and acceptability during a multidisciplinary inpatient rehabilitation program and determined several clinical outcomes (10-meter distance and 2-minute duration walking tests, Functional Gait Assessment, Nine-Hole-Peg tests, and Tinetti Assessment Tool). RESULTS: Improvements are based on self-reported perceptions of PwP. We observed an improvement of overall physical (average 65%), psychological (average 59%) and social (average 39%) aspects after TC. PwP improved strength (96%), balance (88%), range of motion (88%), body awareness (85%), physical well-being (77%), and fatigue (75%). Furthermore, they self-reported admiration in their social surrounding (42%) and felt more sociable and outgoing (40%). Concerning adherence, practicability and acceptability, TC seems to be feasible for PwP. Treatment adherence was 100%, 70% declared motivation to continue TC, and 96% intended to recommend TC to peers. Furthermore, PwP showed statistically significant improvements in 10-meter walking tests (T0: 7.5 (1.1-13.9), T1: 6.5 (0.1-12.9); p < .01; n = 16), 2-minute walking tests (T0: 149.5 (-111.0-410.0), T1: 177.0 (-140.7-494.7); p < .01; n = 19), Functional Gait Assessment (T0: 26.0 (-24.8-76.8), T1: 28.0 (2.6-53.4); p < .01; n = 15), and Nine-Hole-Peg tests (left: T0: 26.5 (24.3-28.7), T1: 24.1 (22.0-26.3); p < .01; n = 15; right: T0: 26.7 (24.1-29.2), T1: 23.3 (20.8-25.7); p < .01; n = 15). CONCLUSION: The preliminary findings suggest that TC offers an effective and feasible training method that may positively affect PwP overall perceptions of physical and psychosocial health status. The methodological limitations and small sample size limit the study's interpretability. More research is needed to definitely show the scientifically significant benefits of TC to PwP.

The therapeutic effects of climbing: A systematic review and meta-analysis.

OBJECTIVE: Several recent studies show a growing popularity of therapeutic climbing (TC) for patients with various conditions. This could be an attempt to fill the gap left by traditional exercises that do not always address physical, mental, and social well-being. This review provides an overview of the physical, mental, and social effects and safety aspects of climbing for different indications. LITERATURE SURVEY: A literature search was conducted on July 8, 2020 (update search August 26, 2021). We searched MEDLINE via Ovid, Embase, and PubMed and bibliographies of included studies, and we conducted a manual search. METHODOLOGY: Two independent reviewers evaluated the quality of the studies using appropriate Risk of Bias (RoB) tools, and the level of evidence for each domain was graded. Study characteristics and effectiveness data for TC were extracted and synthesized. Meta-analyses were conducted for the three dimensions (physical/mental/social health), using a random-effects model. SYNTHESIS: A total of 112 publications were reviewed, and 22 full-text articles were assessed regarding the eligibility criteria, of which 18 trials involving 568 patients were included. TC is safe and positively affects physical (e.g., fitness, motor control, movement velocity, dexterity, strength), mental (e.g., depressiveness, somatisation, psychoticism, emotion regulation, body perception, self-esteem, fatigue), and social (e.g., social functioning, trust, communication, sense of responsibility) health for individuals with neurological, orthopedic, psychiatric, and pediatric ailments. The meta-analysis showed a statistically significant improvement in the physical dimension favoring the climbing group. Improvements that were not statistically significant were found for the mental/social dimensions in the climbing group. The heterogeneity of data was moderate/high (social/mental dimension), and for the physical dimension, data were homogenous. CONCLUSIONS: The studies investigating TC outline its positive effects in various patient groups. TC is a safe and effective treatment for improving physical/mental/social well-being. This review is based on the best available evidence; however, significant gaps remain in providing sufficiently strong evidence.

Clinical effectiveness and safety of self-expandable implantable bulking agents for faecal incontinence: a systematic review.

PURPOSE: The purpose of this systematic review is to evaluate whether self-expandable implantable vs non-self-expandable injectable bulking agents (second-line therapies) are equal/superior in terms of effectiveness (severity, quality of life [QoL]) and safety (adverse events) for faecal incontinence (FI). METHODS: A systematic review was conducted, and five databases were searched (Medline via Ovid, Embase, Cochrane Library, University of York Centre for Reviews and Dissemination, and International Network of Agencies for Health Technology database). In-/exclusion criteria were predefined according to the PICOS scheme. The Institute of Health Economics risk of bias (RoB) tool assessed studies' internal validity. According to the Grading of Recommendations, Assessment, Development and Evaluation approach, the strength of evidence for safety outcomes was rated. A qualitative synthesis of the evidence was used to analyse the data. RESULTS: The evidence consists of eight prospective single-arm, before-after studies (166 patients) fulfilling the inclusion criteria for assessing clinical effectiveness and safety of implantable bulking agents. FI severity statistically significantly improved in five of seven studies rated by the Cleveland Clinic FI Score and in three of five studies measured by the Vaizey score. Statistically significant improved disease-related QoL was found in one of five studies measured by the FI QoL Score and in one of two studies rated by the American Medical Systems score. Procedure-related adverse events occurred in 16 of 166 patients (i.e., intraoperative complications, anal discomfort and pain). Device-related adverse events occurred in 48 of 166 patients, including prostheses' dislodgement and removed/extruded prostheses. Studies were judged with moderate/high RoB. The strength of evidence for safety was judged to be very low. CONCLUSION: Implantable bulking agents might be an effective and safe minimally invasive option in FI treatment if conservative therapies fail. FI severity significantly improved, however, effects on QoL need to be explored in further studies. Due to the uncontrolled nature of the case series, comparative studies need to be awaited.

National Strategies for Preventing and Managing Non-communicable Diseases in Selected Countries.

Non-communicable diseases (NCDs) are the leading cause of death worldwide and are responsible for a high burden of disease. Many countries have developed national strategies for the management and prevention of NCDs to improve the care of chronically ill people or prevent NCDs. This article aims to provide an overview of national NCD strategies from selected countries and their implementation. The focus was on cardiovascular and chronic respiratory diseases, diabetes type II, and depression. A comprehensive, structured hand search was conducted in various databases and websites for national strategies on the 4 NCDs. According to pre-defined criteria, 18 strategies from 8 countries (Germany, Switzerland, Netherlands, Finland, Ireland, United Kingdom, Canada, Australia) were selected. The included NCD strategies differ considerably in terms of level of detail, structure and implementation. All strategies include information on planned activities, but only a few provide detailed information on these interventions, including their evaluation. A structured approach from the macro to the micro level seems crucial for a comprehensive, coordinated overall policy. Strategies should be evaluated regularly using appropriate methods to measure target achievement. For the prevention and management of NCDs, it is important to start in early childhood and to adequately consider the social determinants of health with a "Health in All Policies" approach.

Effectiveness of music therapy for autism spectrum disorder, dementia, depression, insomnia and schizophrenia: update of systematic reviews.

BACKGROUND: Music therapy (MT) aims at maintaining, restoring and furthering physical/emotional/mental health. This review assesses effectiveness of MT and its methods for autism spectrum disorder (ASD), dementia, depression, insomnia and schizophrenia. METHODS: A search for systematic reviews and health technology assessment reports was conducted and yielded 139 hits. Given the large amount, we focused on five frequent diagnostic groups with available Cochrane reviews. A second search was conducted in four databases. Two authors independently performed study selection, data extraction and assessed methodological quality. Only trials with moderate/low risk of bias (RoB) were selected. RESULTS: Ten randomized controlled trials (1.248 participants) met inclusion criteria. For schizophrenia, no studies with low/moderate RoB were found; therefore, updating was not possible. The Cochrane authors stated that quality of life (QoL), social functioning, global/mental state improved for schizophrenia, but not global functioning. For ASD, MT improved behaviour, social communication, brain connectivity and parent-child relationship. For depression, mood was enhanced, and for insomnia, sleep quality, stress, anxiety, total sleep time, disease severity and psychological QoL improved. MT positively affected mood, neuropsychiatric behaviour, apathy, communication and physical functions for dementia; behavioural/psychological symptoms improved only in severe, and memory and verbal fluency only in mild Alzheimer's disease. Cognition improved for dementia in one of four studies. Both active (playing music) and receptive (listening to music) methods were used for dementia, whereas for ASD and depression, active methods were applied. For insomnia, only receptive methods were used. CONCLUSION: These findings provide evidence that MT helps patients improving their physical/psychosocial health. More research investigating long-term effects is needed.

A randomised controlled trial on effectiveness and feasibility of sport climbing in Parkinson's disease.

Physical activity is of prime importance in non-pharmacological Parkinson's disease (PD) treatment. The current study examines the effectiveness and feasibility of sport climbing in PD patients in a single-centre, randomised controlled, semi-blind trial. A total of 48 PD patients without experience in climbing (average age 64 ± 8 years, Hoehn & Yahr stage 2-3) were assigned either to participate in a 12-week sport climbing course (SC) or to attend an unsupervised physical training group (UT). The primary outcome was the improvement of symptoms on the Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale part III (MDS-UPDRS-III). Sport climbing was associated with a significant reduction of the MDS-UPDRS-III (-12.9 points; 95% CI -15.9 to -9.8), while no significant improvement was to be found in the UT (-3.0 points; 95% CI -6.0 to 0.1). Bradykinesia, rigidity and tremor subscales significantly improved in SC, but not in the unsupervised control group. In terms of feasibility, the study showed a 99% adherence of participants to climbing sessions and a drop-out rate of only 8%. No adverse events occurred. This trial provides class III evidence that sport climbing is highly effective and feasible in mildly to moderately affected PD patients.

How COVID-19 will boost remote exercise-based treatment in Parkinson's disease: a narrative review.

The lack of physical exercise during the COVID-19 pandemic-related quarantine measures is challenging, especially for patients with Parkinson's disease (PD). Without regular exercise not only patients, but also nursing staff and physicians soon noticed a deterioration of motor and non-motor symptoms. Reduced functional mobility, increased falls, increased frailty, and decreased quality of life were identified as consequences of increased sedentary behavior. This work overviews the current literature on problems of supplying conventional physiotherapy and the potential of telerehabilitation, allied health services, and patient-initiated exercise for PD patients during the COVID-19 period. We discuss recent studies on approaches that can improve remote provision of exercise to patients, including telerehabilitation, motivational tools, apps, exergaming, and virtual reality (VR) exercise. Additionally, we provide a case report about a 69-year-old PD patient who took part in a 12-week guided climbing course for PD patients prior to the pandemic and found a solution to continue her climbing training independently with an outdoor rope ladder. This case can serve as a best practice example for non-instructed, creative, and patient-initiated exercise in the domestic environment in difficult times, as are the current. Overall, many recent studies on telemedicine, telerehabilitation, and patient-initiated exercises have been published, giving rise to optimism that facilitating remote exercise can help PD patients maintain physical mobility and emotional well-being, even in phases such as the COVID-19 pandemic. The pandemic itself may even boost the need to establish comprehensive and easy-to-do telerehabilitation programs.