Effects of a Remote Mental and Physical Practice Intervention on Freezing of Gait in People with Parkinson Disease: a Single-Blind Randomized Controlled Trial Protocol

BackgroundFreezing of gait (FOG) is a common motor symptom in Parkinsons disease (PD), increasing the risk of falls and reducing independence and quality of life. Effective management combines pharmacological treatment and, when necessary, surgical intervention with targeted strategies aimed at improving gait through compensatory brain networks. Mental Practice (MP), which consists of mentally rehearsing movements, has been studied as a possible strategy to facilitate gait through goal-directed motor control. However, there is limited evidence regarding its therapeutic effects on FOG. This study aims to compare the effects of a novel intervention combining MP based on Dynamic Neuro-Cognitive Imagery (DNI) and Physical Practice (PP) with a control intervention involving PP only, both delivered remotely on the severity of FOG episodes in individuals with PD. MethodsA single-blind, controlled, and randomized trial is proposed. People with idiopathic PD who answered positively to the first question of New Freezing of Gait Questionnaire (NFOG-Q) will be randomly allocated into the Experimental Group (EG) and Control Group (CG). Both groups will undergo 10 remote intervention sessions lasting 45 - 60 minutes with identical volume and intensity, differing only in the MP components. The EG will perform sessions of MP combined with PP, while the CG will perform sessions of PP and stretching. They will be assessed before intervention (BI), after intervention (AI), and 30 days after the intervention, as a follow-up (FU). Primary outcomes included the time to complete the Rapid Turn Test, and the Percentage of time spent with FOG during the test (%FOG). Secondary outcomes included the NFOG-Q, the Movement Disorders Society - Unified Parkinsons Disease Rating Scale (MDS-UPDRS), the Parkinsons Disease Questionnaire-39 (PDQ-39), and the Telephone Montreal Cognitive Assessment (T-MoCA). A repeated measures ANOVA will be used for statistical analysis. DiscussionThe main hypothesis is that both interventions, which are similar in terms of volume, intensity, and progression of complexity, will positively affect the FOG severity. However, experimental intervention combining MP and PP is expected to produce better outcomes than the control intervention. If this hypothesis is confirmed, the study could significantly impact the treatment of people with PD by providing a low-cost and widely accessible option. Administrative informationNote: The numbers in curly bracelets in this protocol refer to SPIRIT checklist item numbers. The order of the items has been modified to group similar items. O_TBL View this table: org.highwire.dtl.DTLVardef@211b37org.highwire.dtl.DTLVardef@181bd13org.highwire.dtl.DTLVardef@a42c31org.highwire.dtl.DTLVardef@51630aorg.highwire.dtl.DTLVardef@13d5f21_HPS_FORMAT_FIGEXP M_TBL C_TBL