Predictors of Gait Improvement in Patients With Parkinson's Disease After Rehabilitation
Condition: Parkinson Disease; Movement Disorders
MeSH terms: Parkinson Disease; Movement Disorders
Study type: Observational

Summary: 
      Patients with Parkinson's disease show a gait disturbance which is considered as one of the
      most disabling aspect of the disease that strongly impacts on patients' autonomy and quality
      of life. The mechanism underlying gait impairment is multi-factorial, reflects the global
      motor impairment of patients with PD and is mainly related to a neurotransmitter deficiency
      inducing bradykinesia, rigidity, abnormal trunk control and postural instability. For this
      reason, and considering the impact of social and economic costs, one of the main foci of
      intervention in patients with PD should be treating gait abnormalities. This need is further
      reinforced by the knowledge that gait outcomes are correlated with longevity, cognitive
      decline and adverse events.

      Besides the shorten-step gait clinical description of the gait disorder in PD, in the last
      years, studies using modern 3D motion analysis systems have further detailed the gait pattern
      in PD disclosing abnormalities in cadence, stance duration, swing duration, double support
      duration, leg length, step length, velocity, hip, knee and ankle ROMs. Such abnormal gait
      parameters seem to correlate with the clinical outcomes of UPDRS score, H-Y stage and
      milliequivalents of levodopa taken. Importantly, gait parameters can either normalize or
      improve after several rehabilitative treatment strategies including physiotherapy, assistive
      equipment, sensory cueing, treadmill training, physical activity, home base exercises.
      However, none of the previous studies specifically investigated which biomechanical factor
      can be modified after rehabilitation and which clinical characteristic can predict the
      rehabilitation-induced gait improvement. This would be extremely important to typifying,
      grouping and selecting patients, optimizing the rehabilitative strategies and cost
      management.

      The aims of the present study were to evaluate in a sample of patients with PD: i) which gait
      parameters can be modified after a short-term rehabilitation program; ii) which, if any,
      clinical variable can predict the improvement of the gait function after rehabilitation. At
      this aim we quantitatively evaluated the gait performance of PD patients by means of a 3-D
      motion analysis system.
    

Detailed description: 
      Fifty out of 67 patients with idiopathic PD assessed for eligibility were recruited at
      Rehabilitation Unit of Department of Medical and Surgical Sciences and Biotechnologies,
      University of Rome, Sapienza, and at Rehabilitation Unit of Policlinico Italia Centre, Rome,
      Italy. Patients were admitted for outpatient rehabilitation between May 2014 and April 2017.
      The inclusion criteria were a diagnosis of idiopathic PD according to UK bank criteria and
      Hoehn and Yahr stages 1 to 3. All patients were in a stable drug program and had adapted to
      their current medications for at least 2 weeks. Exclusion criteria were: cognitive deficits
      (defined as scores of <26 on the Mini-Mental State Examination [MMSE]), moderate or severe
      depression (defined as scores of >17 on the Beck Depression Inventory [BDI]), and orthopedic
      and other gait-influencing diseases such as arthrosis or total hip joint replacement.

      All participants could walk independently without walking devices. All patients were taking
      oral administrations of levodopa (18 patients), dopamine agonists (5 patients), or both (13
      patients) and were recorded in on phase.

      Severity of parkinsonism was evaluated using the Unified Parkinson's Disease Rating Scale
      (UPDRS-II and III) and the Hoehn and Yahr staging system.

      The study complied with the Helsinki Declaration and received local ethics committee
      approval. Prior to taking part in the study, all the participants gave a written consent
      after a fully explanation of the experimental procedure.
    

Intervention name(s): Rehabilitation program
Intervention type(s): Other
Intervention description(s): all patients received a rehabilitation program planned according to the European Physiotherapy guideline for Parkinson's disease and focus on:
endurance, strength, flexibility and balance with functional practice for all H/Y stage
endurance also for H/Y stage 1,
motor learning principles and cue functional for H/Y stage 2-3
external cues and self-instruction strategies and attention H/Y for stage 2-3 The rehabilitative program comprised 60-minute sessions a day (3d/wk).
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Fifty out of 67 patients with idiopathic PD assessed for eligibility were recruited at
        Rehabilitation Unit of Department of Medical and Surgical Sciences and Biotechnologies,
        University of Rome, Sapienza, and at Rehabilitation Unit of Policlinico Italia Centre,
        Rome, Italy. Patients were admitted for outpatient rehabilitation between May 2014 and
        April 2017. All patients were in a stable drug program and had adapted to their current
        medications for at least 2 weeks.

        All participants could walk independently without walking devices. All patients were taking
        oral administrations of levodopa (18 patients), dopamine agonists (5 patients), or both (13
        patients) and were recorded in on phase. Patients' clinical and anthropometric
        characteristics.

        Severity of parkinsonism was evaluated using the Unified Parkinson's Disease Rating Scale
        (UPDRS-II and III) and the Hoehn and Yahr staging system.
      
Keywords: Parkinson disease; movement Disorders; gait disturbance; Parkinson; Parkinson gait; 3D motion analysis systems; motion analysis; Parkinson rehabilitation; rehabilitation gait improvement; gait improvement; SMART Capture; MATLAB software