Defining the Clinically Meaningful Difference in Gait Speed in Persons With Parkinson Disease

Hass, Chris J.; Bishop, Mark D.; Moscovich, Mariana; Stegemöller, Elizabeth L.; Skinner, Jared W.; Malaty, Irene A.; Shukla, Aparna Wagle; McFarland, Nikolaus R.; Okun, Michael S.

doi:10.1097/npt.0000000000000055

Cited by 131 publications

(106 citation statements)

References 38 publications

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“…35 Minimal detectable change and clinically important differences, based on data distribution and effect size metrics, have only been established for on medication gait velocity in people with PD. 36–39 On a group level, a 0.06 m/s improvement in on medication comfortable gait velocity has been associated with moderate clinically important difference in the UPDRS. 39 In the current study, the average improvement in both groups met or exceeded 0.06 m/s.…”

Section: Discussionmentioning

confidence: 99%

“…36–39 On a group level, a 0.06 m/s improvement in on medication comfortable gait velocity has been associated with moderate clinically important difference in the UPDRS. 39 In the current study, the average improvement in both groups met or exceeded 0.06 m/s. 39 At an individual level, the minimal detectable change values for on medication gait velocity in people with PD, based on a 95% CI and measurement reliability are 0.09 m/s for comfortable gait velocity and 0.13 m/s for fast gait velocity.…”

Section: Discussionmentioning

confidence: 99%

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Effects of 2 Years of Exercise on Gait Impairment in People With Parkinson Disease: The PRET-PD Randomized Trial

Rafferty

Prodoehl

Robichaud

et al. 2017

Journal of Neurologic Physical Therapy

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Background and Purpose This study presents a secondary analysis from the Progressive Resistance Exercise Training in Parkinson disease (PRET-PD) trial investigating the effects of progressive resistance exercise (PRE) and a PD-specific multimodal exercise program, modified Fitness Counts (mFC), on spatial, temporal, and stability-related gait impairments in people with Parkinson disease (PD). Methods Forty-eight people with PD were randomized to participate in PRE or mFC 2×/week for 24 months; 38 completed the study. Gait velocity, stride length, cadence, and double support time were measured under 4 walking conditions (off/on medication, comfortable/fast speed). Ankle strength was also measured off and on medication. Twenty-four healthy controls provided comparison data at one time point. Results At 24 months, there were no significant differences between exercise groups. Both groups improved fast gait velocity off medication, cadence in all conditions, and plantarflexion strength off/on medication. Both groups with PD had more gait measures that approximated the heathy controls at 24 months than at baseline. Plantarflexion strength was significantly associated with gait velocity and stride length in people with PD at baseline and 24 months, but changes in strength were not associated with changes in gait. Discussion and Conclusions Twenty-four months of PRE and mFC were associated with improved off medication fast gait velocity and improved cadence in all conditions, which is important because temporal gait measures can be resistant to medications. Spatial and stability-related measures were resistant to long-term improvements, but did not decline over 24 months. Strength gains did not appear to transfer to gait. Video Abstract available for more insights from the authors (see Supplemental Digital Content 1).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effects of 2 Years of Exercise on Gait Impairment in People With Parkinson Disease: The PRET-PD Randomized Trial

Rafferty

Prodoehl

Robichaud

et al. 2017

Journal of Neurologic Physical Therapy

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“…Even in this small sample, we detected substantial variability in activity and time in bed within and across participants, observed that passively measured gait speed at home is slower than the measurement in the clinic [16], and assessed and visually represented patterns of daily activity and sleep. Device-derived measures correlate well with typical PD measures and offer a number of advantages.…”

Section: Discussionmentioning

confidence: 99%

Passive Monitoring at Home: A Pilot Study in Parkinson Disease

et al. 2019

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We conducted a pilot study using a passive radio-wave-based home monitor in individuals with Parkinson disease (PD) with a focus on gait, home activity, and time in bed. We enrolled 7 ambulatory individuals to have the device installed in the bedroom of their homes over 8 weeks and performed standard PD assessments at baseline. We evaluated the ability of the device to objectively measure gait and time in bed and to generate novel visualizations of home activity. We captured 353 days of monitoring. Mean gait speed (0.39–0.78 m/s), time in bed per day (4.4–12.1 h), and number (1.4–5.9) and duration (15.0–49.8 min) of nightly awakenings varied substantially across and within individuals. Derived gait speed correlated well with the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale total (r = –0.88, p = 0.009) and motor sub-score (r = –0.95, p = 0.001). Six of the seven participants agreed that their activity was typical and indicated a willingness to continue monitoring. This technology provided promising new insights into the home activities of those with PD and may be broadly applicable to other chronic conditions.

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“…We think that our data are noteworthy for physicians, physiotherapists, and researchers. The walking speed of patients with Parkinson's disease has been shown to be related with age, disease severity, and balance in the literature (28,29,30).…”

Section: Discussionmentioning

confidence: 99%

“…Many components of walking have caught the attention of physicians but walking speed is the most important of all (28) because independence in society correlates with walking speed; walking speed is considered as an important clinical marker. Walking speed is a reliable evaluation and can be used to determine the ability of walking in patients with Parkinson's disease (29). We used walking speed as a variable to compare the groups who had and had not fallen.…”

Section: Discussionmentioning

confidence: 99%

Frequency of Falls and Relationship Between Falls, Socio-demographic and Clinical

Soyuer¹,

Cankurtaran²,

Gültekın³

et al. 2017

tnd

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Objective: Falls are major problems for people with Parkinson's disease. This study aimed to determine fall frequency, and the relation of socio-demographic and clinical factors in idiopathic Parkinson's disease (IPH). Materials and Methods:Eighty-seven patients with IPH who were under follow-up in Erciyes University Faculty of Medicine, Neurology Department [37 females (42.5%), and 50 males (57.5%)] were included in the study. The participants were evaluated with neurologic examination, mini-mental state examination, the Unified Parkinson's Disease Rating Scale (UPDRS), 6-meter walking test, turning time, freezing phenomenon, Hoehn and Yahr (H&Y) Scale, and ranking of fear of falls. Fall was recorded as history of fall in the 6 months before testing.Results: A total of 22 (25.3%) patients reported a fall in the 6-month period before testing. Twenty-five patients (28.7%) were stage 1.5, and 22 (25.3%) were stage 2 according to the H&Y Scale. Freezing phenomenon was observed in 34 39.1%) patients. There was no significant difference between patients with and without a history of falls according to age, sex, education, occupation, and marital status (p>0.05). According to disease period, H&Y Scale and the UPDRS, motor, turning time 360 degrees from right, turning time 360 degrees from left, balance defect at 360 degrees right turning, balance defect at 360 degrees left turning, and freezing phenomenon there were no significant difference between those with and without a history of fall (p>0.05). There was a significant difference between those who had fallen and had not fallen according to UPDRS-mental, UPDRS-ADL, degree of fear of falling, 6-m walking time, 6-m walking test, and number of steps (p<0.05). Conclusion:Our study showed that frequency of falls and walking speed, fear of falling, activities of daily living, and mental function are important factors for falls in IPH. Fall assessment in IPH is needed for a multifactorial approach and determining these factors will be helpful for taking measures against falls.

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Defining the Clinically Meaningful Difference in Gait Speed in Persons With Parkinson Disease

Cited by 131 publications

References 38 publications

Effects of 2 Years of Exercise on Gait Impairment in People With Parkinson Disease: The PRET-PD Randomized Trial

Effects of 2 Years of Exercise on Gait Impairment in People With Parkinson Disease: The PRET-PD Randomized Trial

Passive Monitoring at Home: A Pilot Study in Parkinson Disease

Frequency of Falls and Relationship Between Falls, Socio-demographic and Clinical

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