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In neurological patients, Parkinson's disease is the most common disorder leading to gait disturbance and falls. 1 Despite advances in pharmacological treatments and surgical techniques, gait and balance deficits still persist and are associated with loss of independence, immobility and high cost for healthcare systems. 2 Therefore, the development of rehabilitation approaches that work in conjunction with current treatment is important to manage these problems.
Recent systematic reviews concluded that evidence available was insufficient to support or refute the efficacy of physiotherapy in Parkinson's disease or to support the use of one form of physiotherapy over another. 3, 4 Some studies had methodological problems. However, reviewers did comment that the efficacy of physiotherapy was improved by the addition of cueing techniques. Cueing is defined as using external temporal or spatial stimuli to facilitate movement (gait) initiation and continuation. Recent reviews on cueing suggest that it can have an immediate and powerful effect on gait performance in people with Parkinson's disease, indicating improvements in walking speed, step length and step frequency. 5, 6 The influence of cueing has mainly been studied in single-session experiments in laboratory settings. 7, 8, 9, 10, 11 Results show a short-term correction of gait and gait initiation, and suggest that carry-over to uncued performance and its generalisation to activities of daily living (ADL) is limited. Using cues in a therapeutic setting is more complex, as the "modality" of cue delivery (visual, auditory or somatosensory) and the cue "parameter" selected for movement correction (frequency or size of step) have to be adapted to the needs of the patient. Apart from two limited studies on the retention effects of cues, to date no work has evaluated the clinical application and prolonged training effects of cues in the home to improve walking in a functional context. 12, 13 Furthermore, improved mobility with cues may have an adverse effect by distracting attention, increasing the risk of falling. 14, 15
The primary objective of this study was to investigate the efficacy of a home-based cueing programme on parameters of gait, gait-related activity and health-related quality of life in people with Parkinson's disease. We hypothesised that a 3-week period of home-based cueing training would result in measurable improvements of selected gait parameters immediately after treatment, but that...