Effect of A Home-Base Core Stability Exercises in Hereditary ataxia. A Randomized Controlled Trial

Background: Core stability exercises (CSE) have been shown to be effective in improving sitting balance in several neurological diseases, but the evidence is scarce on Hereditary Ataxias (HA). Objective: To evaluate the effectiveness of a home-based CSE program in terms of ataxia severity, sitting balance, balance confidence, gait speed, lower limb motor function, quality of life, health status and falls rate in individuals with HA at short- and long-term. Methods: This is an assessor-blind randomized controlled clinical trial parallel group 1:1. The HA individuals were divided in two groups. Experimental group (EG) performed standard care in addition CSE and control group (CG) standard care. The CSE had a duration of 5-week (1-hour/day). The assessment was performed at baseline, endpoint and follow-up (5-week). The primary outcomes were ataxia severity assessed by the Scale for the Assessment and Rating of Ataxia and sitting balance assessed by Spanish-version of Trunk Impairment Scale 2.0. The secondary outcomes were balance confidence by Activities-specific Balance Confidence (ABC), gait speed by 4-meter walk test (4-MWT), the lower limb motor function by 30-seconds sit-to-stand, quality of life (QoL) by EQ-5D-5L, health status by EQ-5D and falls rate. Results: Twenty-three individuals with mild to moderate HA were recruited the mean age and standard deviation was 51.8 ± 11.10 years. A positive effect was observed favoring to EG in ABC, 4-MWT, EQ-5D-5L, EQ-5D and falls rate. Conclusions: A 5-week home-based CSE improve balance confidence, health status, quality of life (mobility, self-care, usual-activities), gait speed and falls rate in HA individuals.背景：已有研究证实，核心稳定性训练（Core Stability Exercises, CSE）可有效改善多种神经系统疾病患者的坐位平衡能力，但针对遗传性共济失调（Hereditary Ataxias, HA）的相关研究证据仍较为匮乏。 目的：评估为期5周的居家核心稳定性训练方案，对遗传性共济失调患者在短期及长期随访中，于共济失调严重程度、坐位平衡、平衡信心、步行速度、下肢运动功能、生活质量、健康状况及跌倒发生率方面的干预效果。 方法：本研究为采用1:1平行分组的评估者盲法随机对照临床试验。将符合入组标准的遗传性共济失调患者随机分为两组：实验组（EG）在常规治疗基础上附加核心稳定性训练，对照组（CG）仅接受常规治疗。核心稳定性训练周期为5周，每日训练1小时。分别于基线、干预结束时及随访（干预结束后5周）节点开展评估。主要结局指标包括：采用共济失调评定量表（Scale for the Assessment and Rating of Ataxia）评估共济失调严重程度，采用西班牙版躯干功能障碍量表2.0（Spanish-version of Trunk Impairment Scale 2.0）评估坐位平衡能力。次要结局指标包括：通过活动特异性平衡信心量表（Activities-specific Balance Confidence, ABC）评估平衡信心，通过4米步行试验（4-MWT）测定步行速度，通过30秒坐站试验评估下肢运动功能，通过EQ-5D-5L量表评估生活质量（Quality of Life, QoL），通过EQ-5D量表评估健康状况，同时统计跌倒发生率。 结果：本研究共纳入23例轻中度遗传性共济失调患者，其平均年龄及标准差为51.8±11.10岁。结果显示，实验组在活动特异性平衡信心量表评分、4米步行试验结果、EQ-5D-5L评分、EQ-5D评分及跌倒发生率方面均显著优于对照组。 结论：为期5周的居家核心稳定性训练可有效改善遗传性共济失调患者的平衡信心、健康状况、生活质量（涵盖运动能力、自我照护、日常活动维度）、步行速度及跌倒发生率。