Impact of forward and backward walking on gait parameters across parkinson's disease stages and severity: a prospective observational study.

IF 2.2 3区 医学 Q3 CLINICAL NEUROLOGY
Tracy Milane, Nicolas Vuillerme, Pascal Petit, Elke Warmerdam, Robbin Romijnders, Edoardo Bianchini, Walter Maetzler, Clint Hansen
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引用次数: 0

Abstract

Background: Parkinson's disease (PD) is characterized by motor symptoms altering gait domains such as slow walking speed, reduced step and stride length, and increased double support time. Gait disturbances occur in the early, mild to moderate, and advanced stages of the disease in both backward walking (BW) and forward walking (FW), but are more pronounced in BW. At this point, however, no information is available about BW performance and disease stages specified using the Hoehn and Yahr (H&Y) scale. The objectives of this study were to examine the link between clinical scores and gait parameters in PD, and to assess gait parameters in both FW and BW among PD patients in early disease stages (H&Y: 1-2) and advanced disease stages (H&Y: 3-4), as well as among PD patients with mild and moderate disease severity as per the Movement Disorder Society-Unified Parkinson's Disease Rating Scale Part III (MDS-UPDRS III).

Methods: Spatiotemporal gait parameters were analyzed during FW and BW over a 5-meter walkway at a comfortable speed using 3D motion capture. Correlations and regressions between clinical scores and gait parameters were examined. Wilcoxon Mann-Whitney rank sum tests were used to compare PD patients in early and advanced disease stages and assess differences in gait parameters for both FW and BW conditions.

Results: The study included a total of 25 PD patients (aged 65 ± 9 years), among whom 10 were in the H&Y stages 1-2 and 15 in stages 3-4. All participants were evaluated with the MDS-UPDRS III, with 17 having a total score ≤ 32 (mild impairment and disability) and 8 having a total score > 32 (moderate impairment and disability). During BW, PD patients with H&Y stages 1-2 had significantly (p < 0.05) longer step lengths, stride lengths, and a higher walk ratio compared to those with H&Y stage 3-4. Regardless of the walking condition, no difference was found between PD patients with a MDS-UPDRS III total score ≤ 32 and patients with a MDS-UPDRS III total score > 32.

Discussion: The study demonstrates that individuals with PD in H&Y stages 3-4 exhibit compromised FW and BW abilities in comparison to those in stages 1-2. Notably, the disparities are more prominent in the realm of backward walking. These findings substantiate the existence of distinct gait patterns between the early and advanced stages of the disease, with the variations being particularly accentuated in the context of backward walking.

Conclusions: Taken together, our results suggest that backward walking may hold greater clinical utility in assessing and managing PD patients.

Trial registration: The research procedure was approved by the ethical committee of the Medical Faculty of Kiel University (D438/18). The study is registered in the German Clinical Trials Register on 20,200,904 (DRKS00022998).

Abstract Image

Abstract Image

向前和向后行走对帕金森病分期和严重程度步态参数的影响:一项前瞻性观察研究
背景:帕金森病(PD)的特点是运动症状改变步态域,如步行速度慢,步幅和步长减少,双支撑时间增加。步态障碍发生在疾病的早期、轻度至中度和晚期,后退行走(BW)和前进行走(FW)都有,但在后退行走(BW)中更为明显。然而,目前还没有使用Hoehn and Yahr (H&Y)量表指定的体重性能和疾病分期的信息。本研究的目的是检查PD临床评分与步态参数之间的联系,并评估疾病早期(H&Y: 1-2)和晚期(H&Y: 3-4) PD患者的FW和BW步态参数,以及根据运动障碍学会统一帕金森病评定量表第三部分(MDS-UPDRS III)轻度和中度疾病严重程度的PD患者。方法:采用三维运动捕捉技术,以舒适的速度在5米的步道上进行上下行走时的时空步态参数分析。检查临床评分与步态参数之间的相关性和回归性。使用Wilcoxon Mann-Whitney秩和检验来比较早期和晚期PD患者,并评估FW和BW条件下步态参数的差异。结果:共纳入25例PD患者,年龄65±9岁,其中H&Y 1-2期10例,3-4期15例。所有参与者均采用MDS-UPDRS III进行评估,其中17例总分≤32(轻度损伤和残疾),8例总分bbb32(中度损伤和残疾)。在BW期间,H&Y 1-2期的PD患者明显(p . 32;讨论:研究表明,与1-2期的PD患者相比,3-4期的PD患者表现出较差的FW和BW能力。值得注意的是,这种差异在倒走领域更为突出。这些发现证实了在疾病的早期和晚期阶段存在明显的步态模式,这种变化在向后行走的情况下尤为突出。结论:综上所述,我们的研究结果表明,向后行走可能在评估和管理PD患者方面具有更大的临床应用价值。试验注册:研究程序由基尔大学医学院伦理委员会批准(D438/18)。该研究已在德国临床试验注册号20,200,904 (DRKS00022998)注册。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BMC Neurology
BMC Neurology 医学-临床神经学
CiteScore
4.20
自引率
0.00%
发文量
428
审稿时长
3-8 weeks
期刊介绍: BMC Neurology is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of neurological disorders, as well as related molecular genetics, pathophysiology, and epidemiology.
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