Comparing the efficacy of therapeutic Thai acupressure on plantar acupoints and laser cane therapy on freezing of gait in Parkinson's disease: a randomized non-inferiority trial

Yuka Miyahara; Onanong Phokaewvarangkul; Stephen Kerr; Chanawat Anan; Haruki Toriumi; Roongroj Bhidayasiri

doi:10.3389/fneur.2024.1327448

Comparing the efficacy of therapeutic Thai acupressure on plantar acupoints and laser cane therapy on freezing of gait in Parkinson's disease: a randomized non-inferiority trial

Front Neurol. 2024 Jan 29:15:1327448. doi: 10.3389/fneur.2024.1327448. eCollection 2024.

Authors

Yuka Miyahara^{1

2

3}, Onanong Phokaewvarangkul², Stephen Kerr^{4

5}, Chanawat Anan², Haruki Toriumi^{6

7}, Roongroj Bhidayasiri^{2

8}

Affiliations

¹ Doctor of Philosophy Program in Medical Sciences (International Program), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
² Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
³ Wat Pho Thai Traditional Medical School, Bangkok, Thailand.
⁴ Biostatistics Excellence Centre, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
⁵ The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
⁶ Department of Acupuncture, Shonan Keiiku Hospital, Fujisawa, Japan.
⁷ Toriumi Acupuncture Clinic, Tokyo, Japan.
⁸ The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand.

Abstract

Background: ON-freezing of gait (ON-FOG) in Parkinson's disease (PD), often resistant to medication, is linked to sensory deficits and proprioceptive impairment, and results in falls and reduced life quality. While visual cues from a laser cane (LC), which rapidly accesses the motor cortex, are commonly used to compensate for proprioceptive impairment, increased visual reliance may be affected by disease progression. Emerging evidence suggests that modulation of peripheral sensory processing may alleviate ON-FOG, and therapeutic Thai acupressure (TTA) may be a solution. This study aims to evaluate the effect of TTA in alleviating ON-FOG and compare its effectiveness to LC in patients with PD.

Methods: This open-label, non-inferiority trial randomized 90 PD patients with ON-FOG equally into three arms: TTA for plantar nerve stimulation for 96 s, LC for visual cueing, and sham control (SC). Stride length was the primary non-inferiority endpoint [non-inferiority margin: lower limit of 95% confidence interval (CI) above -10 cm in mean change difference in pre- and immediately post-intervention in TTA versus LC (one-sided)]. Secondary outcomes included FOG episodes, double support time, velocity, cadence, step length, timed up and go (TUG) test, and visual analog scale (VAS) score.

Results: TTA showed non-inferiority to LC in stride length (mean = -0.7 cm; 95% CI: -6.55; 5.15) (one-sided). The improvements with TTA and LC versus SC were comparable between (mean = 13.11 cm; 95% CI: 7.26; 18.96) and (mean = 13.8 cm; 95% CI: 7.96; 19.65) (one-sided). Secondary outcomes favored TTA and LC over SC with improved FOG, velocity, step length, and VAS scores, while only TTA resulted in improved double support time, cadence, and TUG test results. No complications occurred.

Conclusion: The efficacy of TTA, which improves stride length, is non-inferior to that of LC and consequently alleviates FOG comparable to LC. TTA might enhance proprioceptive function and reduce visual dependence. Therefore, TTA, characterized by its non-invasive, simple, and safe techniques, is a potential non-pharmacological alternative for ON-FOG treatment and might enhance overall quality of life. However, further research into the mechanism, efficacy, and utilization of TTA is essential.

Clinical trial registration: https://www.thaiclinicaltrials.org/show/TCTR20200317001, identifier TCTR20200317001.

Keywords: Parkinson’s disease; acupressure; cues; freezing of gait; neurologic gait disorders; proprioception; quality of life.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This research was generously supported by the 90th Anniversary of Chulalongkorn University Fund under the Ratchadaphiseksomphot Endowment Fund, Batch No. 47(3/63). Additional fundings were provided by the 100th Anniversary Chulalongkorn University for Doctoral Scholarship, Thailand Science Research and Innovation for Senior Research Scholar (RTA6280016), and Chulalongkorn University Centre of Excellence Grant for Centre of Excellence for Parkinson’s Disease and Related Disorders (GCE 3300160003).