The aim of this study was to assess the efficacy of Mézières method in improving trunk flexibility of the back muscles and balance in patients with Parkinson’s disease (PD). Materials and Methods. Thirty-six patients were randomized into 2 groups: the Mézières treatment group and the control group (home exercise group). The primary outcome was the improvement in balance per the Berg Balance Scale (BBS) and the trunk flexibility of the back for the anterior flexion trunk test. Also, we evaluated pain, gait balance for the Functional Gait Assessment (FGA), disease-related disability for the Modified Parkinson’s Activity Scale and the Unified Parkinson’s Disease Rating Scale (UPDRS), the quality of life, and the functional exercise capacity. All the measures were evaluated at baseline (), at the end of the rehabilitative program (), and at the 12-week follow-up (). Results. In the Mézières group, the BBS () and trunk flexion test () improved significantly at and remained the same at . Between groups, significant changes were reported in FGA () and UPDRS Total () at and in FGA () at . Conclusion. The Mézières approach is efficacious in improving the flexibility of the trunk and balance in PD patients.
The Mézières method was created and is used to restore global mobility of joints and muscles, allowing posture reharmonizing, particularly by changing the alignment of the curves of the spine in the sagittal plane [1–3].
In Parkinson’s disease, a tendency to bend or flex forward is the most common change in posture linked to a shortening of the muscular back kinetic chain .
It is not known why this occurs, but it may be due to many factors including muscle rigidity, brain changes that control posture, or dystonia. Muscle rigidity and imbalance of bigger muscles overpowering the smaller muscles can cause the patient to bend over .
Also, patients with PD usually present with impairments in motor control and sensory integration, causing static and dynamic postural control deficits: balance and gait limitations are not fully addressed by pharmacological agents in PD necessitating a nonpharmacological approach as rehabilitation. The existence of a biased representation of verticality in PD, resulting in severe retropulsion and recurrent falls, has prompted interest in a novel rehabilitation method that is dedicated to the sense of verticality [6, 7]. Most conventional and innovative exercises in PD are focused on the motor features of posture and gait, ignoring the perceptive aspects of balance. Introducing perceptive training to the exercises that are proposed for patients with PD is necessary to reduce their static and dynamic balance limitations and increase the efficacy of rehabilitative programs .
PD patients have to rethink their individual motor and cognitive resources to perceive, which is highly challenging in maintaining balance; thus, balance training needs to be specific and progressive . Also, patients with PD have greater postural sway versus healthy subjects, which is significantly associated with a major risk of falls .
There is limited evidence about the efficacy of a specific physiotherapy treatment program over another in improving balance in PD. For example, there is weak evidence that freely coordinated resistance training is more effective than balance training , whereas complementary physical therapies, such as dancing and martial arts, hydrotherapy, virtual reality and exergaming, motor imagery, action observation, and robotic gait training, appear to have therapeutic benefits, increasing mobility and quality of life in certain patients with PD .
A rehabilitative program for PD should be “goal-based” (targeted towards practicing and learning specific activities), but several practice variables (intensity, specificity, and complexity) must be identified, and the program should be tailored to individual patient’s characteristics .
On this basis, between various postural rehabilitation approaches, the Mézières method [1–3] embodies the characteristics that are useful for balance rehabilitation in patients with PD: establishing alignment according to a vertical reference and reminding the patient of motor imagery in perceiving and imagining body posture. Mézières’s concept is a radical shift in therapeutic approaches, valuing relaxation, tonic inhibition, and global and progressive stretching of the muscular regions with imbalances [1–3].
Also, one of the most common nonmotor symptoms of PD is chronic pain. Pain perception is altered in PD, for example, manifesting as elevations in sensory threshold, wherein the interaction between sensory input and motor output modulates pain perception . In particular, lower limb pain is a variant of central pain and merits recognition as a specific nonmotor phenotype in PD . Mézières physiotherapy is effective in other chronic pain conditions, such as low back pain , like other muscle stretching programs, such as the Global Postural Reeducation (GPR) approach; both rehabilitation methods have various levels of progression and advocate stretching the antigravity muscle chains with parallel enhancement of the basal tone of antagonistic muscles to improve static and dynamic stability . To date, there is no published article evaluating the Mézières method alone for people with PD. A few studies utilized this technique as part of a rehabilitation program for individuals with PD [17, 18].
Thus, the aim of this research is to determine the efficacy of the Mézières method in trunk flexibility of the back muscles and balance in patients with Parkinson’s disease (PD).
2. Materials and Methods
We conducted a single-blinded, randomized, controlled trial with a 3-month follow-up to determine the efficacy of a rehabilitative protocol, based on the Mézières method, with regard to balance and posture in patients with PD.
Patients of either gender who had been diagnosed with idiopathic PD for at least 1 year were enrolled from the physical medicine and rehabilitation outpatient clinic of Policlinico Umberto I Hospital, Sapienza University of Rome (Italy), and the neurological outpatient clinics of S. Camillo-Forlanini Hospital and S. Giovanni Battista Hospital of Rome (Italy) from July 2015 to January 2016. Eligible patients were referred to a physiatrist who was uninvolved in the study, who provided them with detailed information on the experimental protocol and performed a standardized, blinded assessment at baseline and at the follow-up to minimize potential bias when performing the clinical examination and recording the data. To maintain the blinding and limit the risk of biased observations, the examiner did not have access to the clinical examination results.
To ensure that participants were assessed under similar conditions during each examination session, all procedures were completed within 1-2 h after the patients took their medications, allowing the participants to feel comfortable and safe during the examination and the results to be representative of how a subject performed a similar task in everyday life. All tests were performed during the “on” phase.
Forty-six patients were screened, 36 of whom were enrolled and randomized into 2 groups: the Mézières treatment group (MTG: , median age 66.00 and IQR 18.50) and the home exercise group, or control group (CG: , median age 67.00 and IQR 11.00). A statistician provided a computer-generated randomization list at a ratio of 1 : 1 (MATLAB R2007b®, MathWorks Inc., USA). Sealed envelopes were prepared for each group. Participants received their randomization letter after the first neurological visit was completed.
Patients were recruited after a neurological examination and then subjected to a physiatrist visit. The inclusion criteria were a diagnosis of idiopathic PD with a level on the Hoehn and Yahr scale ≤ 3 (in the “on” phase) , age between 40 and 80 years, Mini-Mental State Examination score > or = 27 [20, 21], other disabling diseases that affected movement and gait, and steady pharmacological treatment with anti-Parkinson agents for at least 1 month.
The exclusion criteria were cognitive . . . [continue]
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