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Effect of Group-Based Rehabilitation Combining Action Observation with Physiotherapy on Freezing of Gait in Parkinson’s Disease

RESEARCH DESIGN COURSE
Critique Journal Article – Journal Club 2019/11/07
Students: Mai Thi Phuc Advisor: Dr. Ya-Ju Chang
ID student: D0707004 Reviewer: Dr. Tsung-Hsun Hsieh

The article, “Effect of Group-Based Rehabilitation Combining Action Observation with Physiotherapy on Freezing of Gait in Parkinson’s Disease”, by Elisa Pelosin et al., 2018 aimed to investigated whether the action observation training (AOT) program may improve freezing of gait (FoG) and mobility in subjects with Pakinson’s disease (PD), when AOT is applied in a group-based setting.
1. The trial address a clearly focused issue.
• The population: Sixty-four participants with PD and FoG.
• The Intervention: The experimental (AOT) group or control group (Landscape Observation training (LOT)), the both underwent a 45-minute training session, twice a week, for 5 weeks.
• The outcomes:
 Primary outcome: FoG severity measured with the new FoG questionnaire.
 Secondary outcome: means of the Timed Up and Go (TUG), 10-meter walking test (10 M-WT), Berg balance scale (BBS).
2. The assignment of patients to treatments was randomised by using a computerized random-number generator by an independent researcher, then was confirm successfully by using Chi-square test and Nonparametric Mann-Whitney U test.
• The method of allocation was described clearly.
• After screening for eligibility and providing informed consent, participants were randomized to 1 of 2 groups: (1) AOT or (2) LOT.
• The allocation to each group was done by one of independent researcher.
• The allocation was controlled for age, gender, education, disease duration and Hoehn and Yahr stage.
3. The patients, health workers and study personnel were not truly blinded. No information was show making to achieve blinding (Patient, data collector, analyzer).
• Patients were unaware of the other experimental groups of the study: no
• Assessments and data analyses were blinded: no
• The assessors were blinded with respect to patients’ allocations and were assigned a numerical code to all of the recorded tests, which were blindly processed by the other investigators: no
4. The groups were similar at the start of the trial. There no significant differences between the groups at entry to the trial reported.
5. Aside from the experimental intervention, all groups in this study were treated equally and followed at same time intervals.
6. All of the patients who entered the trial properly accounted for at its conclusions
7. The p value were less than 0.05 and is statistically significant by using 2-way repeated ANOVA, Post hoc analysis was performed using t-tests instead of Turkey test or Bonferroni test.
• a significant effect of TIME for all the 4 outcomes
• There were significant interactions between group by time in FoG- Q, TUG, and BBS, but in 10-MWT.
• However, result of group main effect was not show for all outcomes at all.
8. The precise was the estimate of the treatment effect
• p-value <0.05 is reported
9. All clinically important outcomes were considered.
10. The benefits that the study achieved are worth the harms and costs. The study provides evidence that AOT group-based training is feasible and effective on FoG and motor performance in PD patients and may be introduced as an adjunctive option in PD rehabilitation program.
Overall, it is a good, well-written article with an important message for public administrators and organizations.
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