Efficacy of osteopathic manipulative treatment on postural control in Parkinsonian patients with Pisa syndrome

Participants

• Number: 24 people (10 female and 14 male)
• Criteria of inclusion: age 50-80 years, with a diagnosis of Parkinson’s disease, Pisa syndrome appeared in the 12 months preceding the recruitment process and with trunk lateral flexion higher than 10 degrees
• Criteria of exclusion: presence of scoliosis or other spinal abnormalities, acute or subacute onset of Pisa syndrome, changes in medication regimen over the last 3 months, a history of severe hip or spine traumas, coexistence of severe neurological or systemic pathologies, major abdominal surgery
• Groups of study: 2 groups obtained by randomization
  • Group 1: Group 1: MIRT with OMT, 12 people (7 female and 5 male, mean age 65.3 years)
  • Group 2: MIRT with sham treatment, 12 people (3 female and 9 male, mean age 70.1 years)

Interventions and evaluations

• Sway area assessment measured through stabilometry at the beginning of the study and after the intervention
  • the test was carried out with eyes open a first time and a second time with eyes closed at a 5-minute interval from each other
  • assessment at the beginning of the study and after the intervention of the trunk lateral flexion and of the kyphotic angle
• Evaluation of the health status in relation to the Parkinson’s disease through UPDRS, mH&Y scale and 6 minutes walking test
• MIRT: specific exercises for the Pisa syndrome divided into 4 phases (warming up exercises, stretching and mobilization; aerobic exercises; occupational therapy; speech therapy and hydrokinesitherapy)
• 4 weekly sessions of OMT or sham treatment
• OMT: structural evaluation for the evaluation of the somatic dysfunctions, treated following specific techniques accordingly
• Sham treatment: evaluation mimicking the OMT one and light touch following a specific sequence and holding each position for 5 minutes

Results

• Primary outcomes: the group with OMT saw a decrease of the sway area measured with eyes closed, unlike the group with sham treatment which saw its increase instead. The difference between these two results was statistically significant
• Secondary outcomes: the trunk lateral flexion and the kyphotic angle decreased in the group with OMT, whereas they remained the same if not even higher in the group with sham treatment. In this case too, the difference between the two results was statistically significant. Moreover, the group with OMT showed a statistically significant improvement, in the 6 minutes walking test.With regard to UPDRS, the score dropped by 30% in both groups by the end of the study, without statistically significant differences between the two groups. There were not statistically significant differences in the sway area measured with eyes open, although the numbers showed a trend similar to the sway area with closed eyes (decrease with OMT and increase with sham treatment)
• Further analyses: the change in the sway area measured with eyes closed resulted as directly proportional to the change in lateral trunk flexion

Discussion

OMT seems to have favored an improvement of the postural control in patients with Parkinson’s disease and Pisa syndrome, as demonstrated by the reduction of the sway area with eyes closed, of the trunk lateral flexion and of kyphotic angle.
It is possible that the peripheral manipulation of the fascial system induced a series of inputs that allowed a better proprioceptive integration at the central level. In fact, deficits in the vestibular system, in relation to the visual system, could be implicated in the emergence of the Pisa syndrome. Nevertheless, to draw better conclusions about this aspect, studies are needed to specifically evaluate the vestibular system function before and after OMT.

Studies with a bigger sample are also needed in order to better verify the results obtained, which showed a large effect size (relevance of the effect obtained).