Determinants of Objectively Measured Physical Functional Performance in Early to Mid‐stage Parkinson Disease

Abstract

Background Parkinson disease (PD) may lead to functional limitations through both motor and non-motor symptoms. While patients with advanced disease have well-documented and profound functional limitations, less is known about the determinants of function in early to mid-stage disease where interventions may be more likely to benefit and preserve function. Objective The objective of the current study was to identify motor, cognitive and gait determinants of physical functional performance in patients with early to mid-stage PD. Design Secondary analysis of cross-sectional baseline data from a randomized clinical trial of exercise. Setting Tertiary academic medical center. Participants 121 patients with early to mid-stage PD. Methods Our functional performance outcomes included: 1) the Continuous Scale Functional Performance Test (CS-PFP; primary outcome); 2) the timed up and go (TUG) tests; and Section 2 (Activities of Daily Living) of the Unified Parkinson's Disease Rating Scale (UPDRS). Explanatory variables included measures of disease severity, motor function, cognitive function, balance and gait. Step-wise linear regression models were used to determine correlations between explanatory variables and outcome measures. Results In our regression models the CS-PFP significantly correlated with walking endurance (six minute walk; r2 = 0.12, p < .0001), turning ability (360 degree turn; r2 = .03, p = .002), attention (brief test of attention; r2 = .01, p = .03), overall cognitive status (Mini-mental State Examination; r2 = .01, p = .04) and bradykinesia (timed tapping; r2 = .02, p = .02). The TUG significantly correlated with walking speed (5 meter walk; r2 = 0.33, p <.0001), stride length (r2 = 0.25, p <.0001), turning ability (360 turn r2 = .05, p = .0003) and attention (r2 = .016, p = .03). Section 2 of the UPDRS was significantly correlated with endurance (r2 = .09, p < .0001), turning ability (r2 = .03, p = .001) and attention (r2 = .01, p = .03). Conclusions Gait, motor and cognitive function all contribute to objectively measured global functional ability in mild to moderate PD. Subjectively measured functional activity outcomes may underestimate the impact of both motor and non-motor symptoms.

Measurement instruments to assess posture, gait, and balance in Parkinson's disease: Critique and recommendations

“…Known‐group validity in PD has been demonstrated by the test's ability to discriminate between early and middle disease stages, postural instability–gait difficulty dominant, and tremor‐dominant types of PD, and fallers and nonfallers . Construct validity in PD was demonstrated by correlations with walking speed, stride length, and turning ability . Responsiveness in PD has been demonstrated by significant differences between pre‐ and postintervention scores in physical and surgical intervention studies and by the test's sensitivity to dopaminergic medication .…”

Effects of Nordic walking training on functional parameters in Parkinson's disease: a randomized controlled clinical trial

“…However, the NW group had less time for these variables, indicating that presented a better functional mobility of walking and a lower risk of falls compared to FW. Thus, reducing the time TUGSS and TUGFS is clinically relevant and significant to reduce the risk of falls (van Eijkeren et al., ; Bretan et al., ; EY et al., ; Kluger et al., ).…”

“…The Parkinson's disease (PD) promotes motor symptoms such as stiffness disorders, resting tremor, bradykinesia, reduced mobility, and speed walk. The motor symptoms, in turn, may limit the functional activities of daily living (ADLs, Kluger et al., ).…”

Socioeconomic status in relation to Parkinson's disease risk and mortality

“…Apart from being a progressive disease substantially impairing patients’ activities of daily living and quality of life even in early to mid-stage, [10,11] PD is also of great public health importance especially given the aging worldwide population. [12,13] In Sweden, total direct healthcare cost for PD patients was estimated at 1.7 billion Swedish kronor during 2009, out of which 48% were costs for outpatient healthcare and drugs.…”