Factors associated with the decline of daytime bed-mobility independence in Parkinson's disease: A cross-sectional study.

Objective: People with Parkinson's disease (PwPD) experience a gradual decline in independence in bed mobility as the disease progresses. Identifying factors associated with non-independence in daytime bed mobility is crucial for developing effective interventions to enhance independence. We investigated factors associated with non-independence in daytime bed mobility in PwPD.

Methods: This cross-sectional study included 109 PwPD (Hoehn & Yahr [HY] stage 2-4) . Patients' bed mobility ability (turning in bed, supine-to-sitting, and sitting-to-supine) was assessed during daytime and categorized into independent and non-independent groups. Potential factors associated with bed-mobility independence were evaluated, including components of the Movement Disorders Society-Unified Parkinson's Disease Rating Scale (rigidity, bradykinesia, tremor, axial symptoms), neck/trunk/hip strength, the Mini-Mental State Examination, and the Trail Making Test-A and B.

Results: The non-independent group showed significantly increased axial symptoms, increased rigidity in the upper and lower limbs and neck, increased upper limb bradykinesia, and decreased trunk flexion/extension strength in all bed-mobility tasks (p<0.05). Multivariate regression analyses showed that axial symptoms, upper limb rigidity, and trunk extension strength were highly discriminative for non-independence in turning in bed (AUC=0.84). Similarly, upper limb rigidity and axial symptoms were predictive of non-independence in supine-to-sitting and sitting-to-supine movements (AUC=0.78, 0.92). A significant difference in axial symptoms between HY4 subgroups was observed only in the sitting-to-supine movement.

Conclusions: Our findings indicate that axial symptoms and upper limb rigidity are key factors contributing to non-independence in daytime bed-mobility tasks among PwPD. Targeting these factors in rehabilitation may help mitigate the decline in bed-mobility independence in PwPD.