Construct validity, responsiveness and minimal important difference of the cumulated ambulation score in older adults with hip fracture in sub-acute rehabilitation facility.

OBJECTIVE: To assess the construct validity, responsiveness and minimal important difference of the cumulated ambulation score in patients with hip fracture in sub-acute rehabilitation facility. DESIGN: Observational, prospective, monocenter, cohort study. SETTING: Rehabilitation Institute. PARTICIPANTS: 456 older adults with hip fracture (≥65 years) admitted for inpatient rehabilitation. MAIN OUTCOME MEASURES: Cumulated ambulation score, functional independence measure and functional ambulation category were collected at admission and discharge. Construct validity and responsiveness were assessed through hypothesis testing and minimal important difference was determined using the anchor-based method; floor and ceiling effects were also assessed. RESULTS: The cumulated ambulation score showed strong correlations with the functional independence measure and functional ambulation category scores at both admission and discharge, satisfying all the hypotheses for construct validity. The effect size of cumulated ambulation score was 1.63. Changes in cumulated ambulation score had a moderate-to-strong correlation with changes of other instruments and were able to discriminate patients improved from those not-improved, and patients classified as independent ambulators from those dependent. A ceiling effect was found only at discharge. The estimated minimal important difference was 2 points. CONCLUSIONS: The cumulated ambulation score showed high levels of construct validity and responsiveness according to the hypothesis testing. A two points improvement at the end of rehabilitation was found to be clinically important in people with hip fracture in the sub-acute phase. The ceiling effect found at discharge suggested the limitation of the scale in assessing people with a partially recovered autonomy in performing postural changes and gait.

Vertical Ground Reaction Forces in Parkinson's Disease: A Speed-Matched Comparative Analysis with Healthy Subjects.

This study aimed to investigate and compare the vertical Ground Reaction Forces (vGRFs) of patients with Parkinson's Disease (PwPD) and healthy subjects (HS) when the confounding effect of walking speed was absent. Therefore, eighteen PwPD and eighteen age- and linear walking speed-matched HS were recruited. Using plantar pressure insoles, participants walked along linear and curvilinear paths at self-selected speeds. Interestingly, PwPD exhibited similar walking speed to HS during curvilinear trajectories (p = 0.48) and similar vGRF during both linear and curvilinear paths. In both groups, vGRF at initial contact and terminal stance was higher during linear walking, while vGRF at mid-stance was higher in curvilinear trajectories. Similarly, the time to peak vGRF at each phase showed no significant group differences. The vGRF timing variability was different between the two groups, particularly at terminal stance (p < 0.001). In conclusion, PwPD and HS showed similar modifications in vGRF and a similar reduction in gait speed during curvilinear paths when matched for linear walking speed. This emphasized the importance of considering walking speed when assessing gait dynamics in PwPD. This study also suggests the possibility of the variability of specific temporal measures in differentiating the gait patterns of PwPD versus those of HS, even in the early stages of the disease.

Addition of aerobic training to conventional rehabilitation after hip fracture: a randomized, controlled, pilot feasibility study.

OBJECTIVES: To determine the feasibility and safety of aerobic training with an arm crank ergometer and its effectiveness in improving functional capacity and gait in patients with recent hip fracture. DESIGN: Randomized, controlled, assessor-blinded pilot study, with intention-to-treat analysis. SETTING: Inpatients, rehabilitation department. SUBJECTS: 40 patients with hip fracture surgically treated. INTERVENTIONS: Training group performed aerobic exercise with an arm crank ergometer (15 sessions, 30 minutes/day) at an intensity of 64% to 76% of maximum heart rate, in addition to conventional inpatient rehabilitation. MAIN MEASURES: Primary outcome was the feasibility (including eligibility rate, recruitment rate, number of drop-outs and adverse events, adherence). Secondary measures were the Timed Up and Go test, ability to walk independently, muscle torque of knee extensors of fractured and non-fractured leg, Functional Independence Measure. RESULTS: Mostly due to pre-existing disability and fracture type, only 40/301 (13%) patients were eligible (age 84.6 ± 7.6 years, 75% female); all agreed to participate and 90% completed the trial, without adverse events. Adherence to aerobic exercise was good, with high attendance at sessions (93%), a strong compliance to exercise duration (95%) but lower compliance to the prescribed intensity (73%). After the program, more patients were able to walk independently in the training group (n = 18) compared to control (n = 13) (P < 0.05). Also the muscle torque of fractured leg knee extensors was higher in the training group (P < 0.05). CONCLUSION: Aerobic training in addition to conventional rehabilitation after a hip fracture is feasible and safe and it was effective in improving gait performance and strength of fractured leg. TRIAL REGISTRATION: NCT04025866.

Proposal of a new conceptual gait model for patients with Parkinson's disease based on factor analysis.

BACKGROUND: Gait impairment is a risk factor for falls in patients with Parkinson's disease (PD). Gait can be conveniently assessed by electronic walkways, but there is need to select which spatiotemporal gait variables are useful for assessing gait in PD. Existing models for gait variables developed in healthy subjects and patients with PD show some methodological shortcomings in their validation through exploratory factor analysis (EFA), and were never confirmed by confirmatory factor analysis (CFA). The aims of this study were (1) to create a new model of gait for PD through EFA, (2) to analyze the factorial structure of our new model and compare it with existing models through CFA. RESULTS: From the 37 variables initially considered in 250 patients with PD, 10 did not show good-to-excellent reliability and were eliminated, while further 19 were eliminated after correlation matrix and Kaiser-Meyer-Olkin measure. The remaining eight variables underwent EFA and three factors emerged: pace/rhythm, variability, and asymmetry. Structural validity of our new model was then examined with CFA, using the structural equation modeling. After some modifications, suggested by the Modification Indices, we obtained a final model that showed an excellent fit. In contrast, when the structure of previous models of gait was analyzed, no model achieved convergence with our sample of patients. CONCLUSIONS: Our model for spatiotemporal gait variables of patients with PD is the first to be developed through an accurate EFA and confirmed by CFA. It contains eight gait variables divided into three factors and shows an excellent fit. Reasons for the non-convergence of other models could be their inclusion of highly inter-correlated or low-reliability variables or could be possibly due to the fact that they did not use more recent methods for determining the number of factors to extract.

Correction to: Proposal of a new conceptual gait model for patients with Parkinson's disease based on factor analysis.

It was highlighted that the original article [1] had an omission in the Abstract. This Correction article shows the omitted sentence: "This article [1] was awarded the SIAMOC Best Methodological Paper 2018".

Instrumental or Physical-Exercise Rehabilitation of Balance Improves Both Balance and Gait in Parkinson's Disease.

We hypothesised that rehabilitation specifically addressing balance in Parkinson's disease patients might improve not only balance but locomotion as well. Two balance-training protocols (standing on a moving platform and traditional balance exercises) were assessed by assigning patients to two groups (Platform, n = 15, and Exercises, n = 17). The platform moved periodically in the anteroposterior, laterolateral, and oblique direction, with and without vision in different trials. Balance exercises were based on the Otago Exercise Program. Both platform and exercise sessions were administered from easy to difficult. Outcome measures were (a) balancing behaviour, assessed by both Index of Stability (IS) on platform and Mini-BESTest, and (b) gait, assessed by both baropodometry and Timed Up and Go (TUG) test. Falls Efficacy Scale-International (FES-I) and Parkinson's Disease Questionnaire (PDQ-8) were administered. Both groups exhibited better balance control, as assessed both by IS and by Mini-BESTest. Gait speed at baropodometry also improved in both groups, while TUG was less sensitive to improvement. Scores of FES-I and PDQ-8 showed a marginal improvement. A four-week treatment featuring no gait training but focused on challenging balance tasks produces considerable gait enhancement in mildly to moderately affected patients. Walking problems in PD depend on postural instability and are successfully relieved by appropriate balance rehabilitation. This trial is registered with ClinicalTrials.gov NCT03314597.

Minimal clinically important difference of the functional independence measure in older adults with hip fracture.

PURPOSE: To investigate the responsiveness and minimal clinically important difference (MCID) of the Functional Independence Measure (FIM) from a clinician's perspective in hip-fractured elderly undergoing inpatient rehabilitation. MATERIALS AND METHODS: Data of 701 hip-fractured elderly admitted to our rehabilitation institute were retrospectively collected. Ten a priori hypotheses were formulated. RESULTS: The effect size of the FIM scores after treatment were large (total = 1.38, motor = 1.78). Moderate correlations were found between the change total score of FIM and Barthel Index (BI, rs = 0.51), Functional Ambulation Categories (FAC, rs = 0.52) and a checklist regarding participants' independence in transfers (rs = 0.59). The area under the receiving operating characteristics were 0.82, 0.81, and 0.85 when BI, FAC and checklist were used as anchors, respectively. Based on these findings, the FIM showed high responsiveness (9/10 hypotheses met). Triangulation of findings showed that MCIDs of 22 and 21 points were the most appropriate for the FIM total and motor score, respectively. CONCLUSIONS: The FIM scale is appropriate for assessing independence and functional recovery in hip-fractured elderly. Improvements of 22 and 21 points at the total and motor FIM were identified as indicators of minimal clinical change in those admitted to a rehabilitation facility with an FIM total score between 40 and 80.

This study provides evidence of the high responsiveness of the Functional Independence Measure (FIM) total score and of its motor subscore, while the cognitive subscore is not responsive to change among older adults with hip fractures hospitalized for rehabilitation.After a rehabilitative program, a change of at least 22 points in the FIM total score is clinically important in older adults with hip fractures.This change scores will be useful for researchers and clinicians in order to determine a possible clinically meaningful improvement in independence as a response to rehabilitation after a hip fracture.

The Effect of Upright Stance and Vision on a Cognitive Task in Elderly Subjects and Patients with Parkinson's Disease.

Standing compared to sitting enhances cognitive performance in healthy subjects. The effect of stance on cognitive performance has been addressed here in patients with Parkinson's disease (PwPD). We hypothesized that a simple cognitive task would be less enhanced in PwPD by standing with respect to sitting, because of a larger cognitive effort for maintenance of standing posture than in healthy subjects. We recruited 40 subjects (20 PwPD and 20 age-matched healthy subjects, HE). Each participant performed an arithmetic task (backward counting aloud by 7) in two postural states, sitting and standing, with eyes open (EO) and with eyes closed (EC). All trials lasted 60 s and were randomized across subjects and conditions. The number of correct subtractions per trial was an index of counting efficiency and the ratio of correct subtractions to total subtractions was an index of accuracy. All conditions collapsed, the efficiency of the cognitive task was significantly lower in PwPD than HE, whilst accuracy was affected to a lower extent. Efficiency significantly improved from sitting to standing in HE under both visual conditions whilst only with EO in PwPD. Accuracy was not affected by posture or vision in either group. We suggest that standing, compared to sitting, increases arousal, thus improving the cognitive performance in HE. Conversely, in PwPD this improvement was present only with vision, possibly due to their greater balance impairment with EC consuming an excess of attentional resources. These findings have implications for balance control and the risk of falling in PwPD in the absence of visual cues.

Comparison of Two Techniques Performing the Supine-to-Sitting Postural Change in Patients with Sternotomy.

Patients with sternotomy are advised to follow sternal precautions to avoid the risk of sternal complications. However, there are no standard recommendations, in particular to perform the supine-to-sitting postural change, where sternal asymmetrical force may be applied. The aim of this study was to compare the rotational movement and the use of a tied rope (individual device for supine-to-sitting, "IDSS") to perform the supine-to-sitting postural change. A total of 92 patients (26% female) admitted to a rehabilitative post-surgery ward with sternotomy were assessed for sternal instability. Levels of pain and perceived effort during the two modalities of postural change and at rest were assessed. Patients reported higher values of pain and perceived effort (both p < 0.0005) during rotational movement with respect to the use of the IDSS. Moreover, patients with sternal instability (14%) and female patients with macromastia (25%) reported higher pain than those stable or without macromastia (both p < 0.05). No other risk factors were associated with pain. Thus, the IDSS seems to reduce the levels of pain and perceived effort during the supine-to-sitting postural change. Future studies with quantitative assessments are required to suggest the adoption of this technique, mostly in patients with high levels of pain or with sternal instability.

Writing Blindly in Incomplete Locked-In Syndrome with A Custom-Made Switch-Operated Voice-Scanning Communicator-A Case Report.

BACKGROUND: Locked-In Syndrome (LIS) is a rare neurological condition in which patients' ability to move, interact, and communicate is impaired despite their being conscious and awake. After assessing the patient's needs, we developed a customized device for an LIS patient, as the commercial augmentative and alternative communication (AAC) devices could not be used. METHODS: A 51-year-old woman with incomplete LIS for 15 years came to our laboratory seeking a communication tool. After excluding the available AAC devices, a careful evaluation led to the creation of a customized device (hardware + software). Two years later, we assessed the patient's satisfaction with the device. RESULTS: A switch-operated voice-scanning communicator, which the patient could control by residual movement of her thumb without seeing the computer screen, was implemented, together with postural strategies. The user and her family were generally satisfied with the customized device, with a top rating for its effectiveness: it fit well the patient's communication needs. CONCLUSIONS: Using customized AAC and strategies provides greater opportunities for patients with LIS to resolve their communication problems. Moreover, listening to the patient's and family's needs can help increase the AAC's potential. The presented switch-operated voice-scanning communicator is available for free on request to the authors.

Effects of Aerobic Training in Patients with Subacute COVID-19: A Randomized Controlled Feasibility Trial.

Many clinical practice recommendations indicate rehabilitation as essential for patients with sequelae of severe or critical COVID-19 and suggest the prompt initiation of a multicomponent rehabilitation program focused on aerobic and endurance training. However, randomized controlled trials (RCTs) regarding aerobic exercise are lacking. Therefore, we aimed to assess the feasibility and effectiveness of the addition of aerobic training to standard rehabilitation in subjects with subacute COVID-19. Participants were 32/214 patients with the sequelae of severe or critical COVID-19 in the acute phase who were eligible and agreed to participate in the study (eligibility = 15%, recruitment = 100%). After randomization and assessment with functional and strength tests, all the participants underwent an inpatient-tailored rehabilitation program (50 min/day, 5 days/week, 10 sessions); in addition, the experimental group performed a low- to moderate-intensity aerobic exercise (30 min/day, 10 sessions). No dropouts or severe adverse events were reported, with an attendance rate of 95.6%. Most of the secondary outcomes significantly improved in both groups, but the improvement in the Functional Independence Measure and Cumulated Ambulation Score-Italian version was significantly greater in the experimental group (at least, p < 0.05). This RCT showed that aerobic exercise is feasible and safe in subacute COVID-19. Moreover, it appears to be beneficial and useful in improving patients' independence and mobility.

Balance performance in patients with post-acute COVID-19 compared to patients with an acute exacerbation of chronic obstructive pulmonary disease and healthy subjects.

COVID-19 leaves important sequelae in patients, not only in those who had the experience of a critical illness but also in patients with severe form. Understanding the impairments allows us to target rehabilitation to patients' real needs; balance impairments are an assumed sequela of COVID-19, but no study has specifically evaluated balance performance in these patients. Their performance was compared to that of patients with a pulmonary disease that leads to systemic diseases, such as patients with an acute exacerbation of chronic obstructive pulmonary disease (PwAECOPD), and of healthy subjects. A total of 75 subjects were assessed: 25 patients with COVID-19 (PwCOVID) with a severe form in the acute phase, 25 PwAECOPD and 25 healthy subjects sex- and age-matched. A stabilometric platform was used to evaluate static balance, both with eyes open and closed, while the dynamic balance was assessed with the Mini-BESTest and the Timed Up and Go test. When compared to healthy subjects, results showed that PwCOVID had worse performance in both static (P < 0.005) and dynamic (P < 0.0001) balance, with a large effect size in all measures (>0.8). Moreover, PwCOVID showed similar results to those of PwAECOPD. In conclusion, PwCOVID showed a balance deficit in both dynamic and static conditions. Therefore, as for PwAECOPD, they should require not only respiratory rehabilitation but also balance and mobility physiotherapy to prevent today's PwCOVID from becoming tomorrow's fallers.

The Coronavirus Footprint on Dual-Task Performance in Post-Acute Patients after Severe COVID-19: A Future Challenge for Rehabilitation.

Recent studies suggest that also the non-critical form of COVID-19 infection may be associated with executive function impairments. However, it is not clear if they result from cognitive impairments or by COVID-19 infection per se. We aimed to investigate if patients in the post-acute stage of severe COVID-19 (PwCOVID), without manifest cognitive deficits, reveal impairments in performing dual-task (DT) activities compared to healthy controls (HS). We assessed balance in 31 PwCOVID vs. 30 age-matched HS by stabilometry and the Timed Up and Go (TUG) test with/without a cognitive DT. The DT cost (DTC), TUG test time and sway oscillations were recorded; correct cognitive responses (CCR) were calculated to evaluate cognitive performance. Results show a significant difference in overall DT performance between PwCOVID and HS in both stabilometry (p < 0.01) and the TUG test (p < 0.0005), although with similar DTCs. The main difference in the DTs between groups emerged in the CCR (effect size > 0.8). Substantially, PwCOVID gave priority to the motor task, leaving out the cognitive one, while HS performed both tasks simultaneously. Our findings suggest that PwCOVID, even without a manifest cognitive impairment, may present a deficit in executive function during DTs. These results encourage the use of DTs and CCR in PwCOVID.

Does the type of hip fracture affect functional recovery in elderly patients undergoing inpatient rehabilitation?

BACKGROUND: Hip fractures should not be considered as a single, homogeneous condition. Various determinants of functional recovery of patients with hip fracture have been proposed, such as age or type of fracture. The aim of this study was to determine if patients with an intertrochanteric fracture (ITF) had lower functional recovery characteristics with respect to those with a femoral neck fracture (FNF). METHODS: A retrospective study was carried out on 531 elderly patients with hip fracture, surgically treated, admitted to a rehabilitation institute between December 1, 2014, and December 31, 2017. Patients underwent an individualized rehabilitation program for improving their physical function. The outcome measures of this study were the length of stay (LOS) in the rehabilitation institute, the Functional Independence Measure (FIM) gain, i.e. the difference in FIM score between discharge and admission, and the FIM efficiency, which represents the daily gain. Patients were also stratified by age categories and by different levels of functional independence, as evaluated with the FIM total score at baseline. RESULTS: Age (p<0.05), LOS (p<0.005) and rehabilitation outcomes (FIM score and efficiency; p<0.05) differed significantly between patients with FNF and ITF. In particular, patients with ITF were older and more dependent at baseline. Moreover, they showed a lower FIM efficiency with respect to patients with FNF (p<0.05), which obtained a similar improvement in FIM total score of about 26 points but were discharged on average 3 days before. With aging, FIM efficiency decreased, while LOS increased. Patients highly dependent at baseline (FIM total score <40) had the lowest FIM gain and efficiency and the longest LOS respect to the more independent patients. Moreover, in older (85+ years) and in higher dependent patients the differences in the outcome measures between ITF and FNF were reduced. CONCLUSIONS: The type of hip fracture could affect the LOS and FIM efficiency of younger and more independent patients with hip fracture during inpatient rehabilitation. In particular, patients with ITF require a longer rehabilitation period to achieve a similar functional gain as those with FNF.

A pathophysiological model of gait captures the details of the impairment of pace/rhythm, variability and asymmetry in Parkinsonian patients at distinct stages of the disease.

Locomotion in people with Parkinson' disease (pwPD) worsens with the progression of disease, affecting independence and quality of life. At present, clinical practice guidelines recommend a basic evaluation of gait, even though the variables (gait speed, cadence, step length) may not be satisfactory for assessing the evolution of locomotion over the course of the disease. Collecting variables into factors of a conceptual model enhances the clinical assessment of disease severity. Our aim is to evaluate if factors highlight gait differences between pwPD and healthy subjects (HS) and do it at earlier stages of disease compared to single variables. Gait characteristics of 298 pwPD and 84 HS able to walk without assistance were assessed using a baropodometric walkway (GAITRite®). According to the structure of a model previously validated in pwPD, eight spatiotemporal variables were grouped in three factors: pace/rhythm, variability and asymmetry. The model, created from the combination of three factor scores, proved to outperform the single variables or the factors in discriminating pwPD from HS. When considering the pwPD split into the different Hoehn and Yahr (H&Y) stages, the spatiotemporal variables, factor scores and the model showed that multiple impairments of gait appear at H&Y stage 2.5, with the greatest difference from HS at stage 4. A contrasting behavior was found for the asymmetry variables and factor, which showed differences from the HS already in the early stages of PD. Our findings support the use of factor scores and of the model with respect to the single variables in gait staging in PD.

Insights Into the Mini-BESTest Scoring System: Comparison of 6 Different Structural Models.

OBJECTIVE: The Mini-Balance Evaluation Systems Test (Mini-BESTest) is a balance scale common to clinical practice, but different scoring has been proposed, that is, total score and/or subsections. This study aimed to investigate Mini-BESTest validity by comparing 6 structural models and to establish the best model for discriminating fallers from nonfallers, that is, those who did or did not report at least 2 falls in the 6 months before evaluation. METHODS: In this cross-sectional validation study, data from 709 individuals with idiopathic Parkinson disease (Hoehn and Yahr stages 1-3) were analyzed. Individuals were evaluated with the Mini-BESTest, and fall history was recorded. Construct, convergent, and discriminant validity and reliability of the 6 models were analyzed. The ability of the models to adequately identify individuals with or without a history of falls was tested with receiving operating characteristic curves. RESULTS: Confirmatory factor analysis showed that the unidimensional models and the 4-factor solutions showed the best fit indexes. Conversely, second-order models, which allowed reporting of both total and subsections, did not converge. Most models and factors showed a low convergent validity (average variance extracted values <0.5). Correlations among the anticipatory postural adjustments factor with both the sensory orientation and the dynamic gait factors of multidimensional models were high (r ≥ 0.85). Unidimensional model reliability was good, whereas low values were found in one-half of the subsections. Finally, both unidimensional models showed a large area under the receiving operating characteristic curve (0.81). CONCLUSION: The original unidimensional Mini-BESTest model-with a total score of 28-showed the highest validity and reliability and was best at discriminating fallers from nonfallers. Conversely, its 4 subsections should not be reported separately, because they were highly correlated and had low reliability; therefore, they are not actually capable of measuring different aspects of balance. IMPACT: This study shows that the Mini-BESTest should be used only with the original unidimensional scoring system in people with Parkinson disease.

Writing with the Eyes: The Effect of Age on Eye-Tracking Performance in Non-Disabled Adults and a Comparison with Bimanual Typing.

Eye-tracking technology is advancing rapidly, becoming cheaper and easier to use and more robust. This has fueled an increase in its implementation for Augmentative and Alternative Communication (AAC). Nowadays, Eye-Tracking Communication Devices (ETCDs) can be an effective aid for people with disabilities and communication problems. However, it is not clear what level of performance is attainable with these devices or how to optimize them for AAC use. The objective of this observational study was to provide data on non-disabled adults' performance with ETCD regarding (a) range of eye-typing ability in terms of speed and errors for different age groups and (b) relationship between ETCD performance and bimanual writing with a conventional PC keyboard and (c) to suggest a method for a correct implementation of ETCD for AAC. Sixty-seven healthy adult volunteers (aged 20-79 years) were asked to type a sample sentence using, first, a commercial ETCD and then a standard PC keyboard; we recorded the typing speed and error rate. We repeated the test 11 times in order to assess performance changes due to learning. Performances differed between young (20-39 years), middle-aged (40-59 years), and elderly (60-79 years) participants. Age had a negative impact on performance: as age increased, typing speed decreased and the error rate increased. There was a clear learning effect, i.e., repetition of the exercise produced an improvement of performance in all subjects. Bimanual and ETCD typing speed showed a linear relationship, with a Pearson's correlation coefficient of 0.73. The assessment of the effect of age on eye-typing performance can be useful to evaluate the effectiveness of man-machine interaction for use of ETCDs for AAC. Based on our findings, we outline a potential method (obviously requiring further verification) for the setup and tuning of ETCDs for AAC in people with disabilities and communication problems.

Responsiveness and minimal clinically important difference of the Mini-BESTest in patients with Parkinson's disease.

BACKGROUND: Balance problems in Parkinson's Disease (PD) require appropriate evaluation. While the Mini-BESTest is commonly used to assess dynamic balance, some of its psychometric properties have not yet been addressed. RESEARCH QUESTION: What is the responsiveness and the Minimal Clinically Important Difference (MCID) of the Mini-BESTest in patients with PD? METHODS: One-hundred forty-eight patients with PD underwent a treatment specific for balance skills (1-h session, three times/week for four weeks). All patients were initially evaluated with the Mini-BESTest and Activities-Specific Balance Confidence scale 5-levels (ABC-5L). Post-treatment, patients were assessed with the Mini-BESTest, ABC-5L and Global Rating of Change (GRC, both patient- and physiotherapist-rated). Responsiveness to treatment and MCID were calculated with distribution and anchor-based methods: effect size, area under the curve (AUC) of receiver operating characteristics (ROC), and correlations between evaluations (change in score of Mini-BESTest, ABC-5L, GRC). Eleven a priori hypotheses were formulated for testing responsiveness. RESULTS: The effect size of treatment measured with the Mini-BESTest was 0.44, revealing moderate responsiveness. AUCs were 0.75, 0.82 and 0.59 for the patient-rated GRC, physiotherapist-rated GRC and ABC-5L, respectively. There was a moderate correlation between changes in the Mini-BESTest and patient-rated (rs = 0.42) or physiotherapist-rated (rs = 0.62) GRC scores. Conversely, a low correlation (rs = 0.17) was found between changes in the Mini-BESTest and ABC-5L. Consequently, 72.7% of hypotheses were met. The Mini-BESTest MCID was between 3.4 and 4.0 when calculated with distribution and anchor-based methods, respectively. SIGNIFICANCE: The Mini-BESTest showed moderate responsiveness for detecting treatment-related improvement in dynamic balance. A 4.0-point MCID value is useful to identify clinical effects of balance rehabilitation in a single patient with PD. Values ranging from 3.4 and 4.0 are recommended for interpretation of results at a group level.

Walking Along Curved Trajectories. Changes With Age and Parkinson's Disease. Hints to Rehabilitation.

In this review, we briefly recall the fundamental processes allowing us to change locomotion trajectory and keep walking along a curved path and provide a review of contemporary literature on turning in older adults and people with Parkinson's Disease (PD). The first part briefly summarizes the way the body exploits the physical laws to produce a curved walking trajectory. Then, the changes in muscle and brain activation underpinning this task, and the promoting role of proprioception, are briefly considered. Another section is devoted to the gait changes occurring in curved walking and steering with aging. Further, freezing during turning and rehabilitation of curved walking in patients with PD is mentioned in the last part. Obviously, as the research on body steering while walking or turning has boomed in the last 10 years, the relevant critical issues have been tackled and ways to improve this locomotor task proposed. Rationale and evidences for successful training procedures are available, to potentially reduce the risk of falling in both older adults and patients with PD. A better understanding of the pathophysiology of steering, of the subtle but vital interaction between posture, balance, and progression along non-linear trajectories, and of the residual motor learning capacities in these cohorts may provide solid bases for new rehabilitative approaches.