The Mini-BESTest is an independent predictor of falls in Parkinson Disease.

BACKGROUND: Falls in Parkinson Disease (PD) are a complex health problem, with multidimensional causes and consequences. OBJECTIVES: To identify the fall predictors in individuals with PD and compare fallers and non-fallers considering their socio-demographic, anthropometric, clinical and functional status. METHODS: A multicenter cross-sectional design was employed. Variables included: age, sex, body mass index, PD progression, levodopa dosage, activities limitation and motor impairments (UPDRS ADL/Motor), level of physical activity (human activity profile - HAP), fear of falls (Falls Efficacy Scale-International-FES-I), freezing of gait (Freezing of Gait Questionnaire - FOG-Q), gait speed (10 meters walk test - 10-MWT), lower limb functional strength (Five Times Sit-to-Stand Test - FTSST), balance (Mini-BESTest), mobility (Timed "Up & Go" - TUG) and dual-task dynamic (TUG-DT). Seventeen potential predictors were identified. Logistic regression and ROC curve were applied. RESULTS: Three-hundred and seventy individuals (44.87% fallers and 55.13% non-fallers) completed the study. Fallers presented worse performance in UPDRS motor/ADL/Total, FES-I, FOG-Q, Mini-BESTest, HAP, TUG and TUG-DT and the majority were inactive. The Mini-BESTest Total was the main independent predictor of falls (OR=0.92; p<0.001; 95% CI=0.89, 0.95). For each one-unit increase in the Mini-BESTest, there was an average reduction of 8% in the probability of being a faller. A cut-off point of 21.5/28 (AUC=0.669, sensitivity 70.7% and specificity 55.1%) was determined. CONCLUSION: Besides characterizing and comparing fallers and non-fallers, this study showed that the Mini-BESTest was the strongest individual predictor of falls in individuals with PD, highlighting the importance of evaluating dynamic balance ability during fall risk assessment.

Determinants of the use of physiotherapy services among individuals with Parkinson's disease living in Brazil.

OBJECTIVES: To identify the factors affecting the use of physiotherapy services among individuals with Parkinson's disease (PD) living in Brazil. METHODS: Overall, 479 individuals with idiopathic PD, of both sexes, at any stage of the Hoehn & Yahr (HY) scale, and from seven capital cities in Brazil were recruited from 2014 to 2016. Multivariate logistic regression was the main statistical tool. For the construction of the logistic model, the association of the dependent variable "physiotherapy" with the independent sociodemographic/economic and clinical variables: age, education, family income, time of PD since onset, HY, the activities of daily living and motor subscales of the Unified Parkinson's Disease Rating Scale, cognitive aspects, depressive symptoms, fear of falling, freezing gait, history of falls, physical activity level, gait speed, walking performance and balance, were verified. RESULTS: The 479 individuals had an average age of 65.2 ± 11.0 years, 88% were in the HY I-III stages and 43.4% were under physiotherapy treatment. The analysis identified two determinant variables related to the use of the physiotherapy service: level of education (OR = 1.24) and walking performance (OR = 0.82). Decreased walking performance and a higher educational level increased the use of a physiotherapy service in individuals with PD living in Brazil. CONCLUSIONS: The present study shows that individuals with PD, residents from different regions of Brazil, have limited access to physiotherapy services. In addition, the Brazilian Public Health Care System, as well as local programs, need to target PD individuals with a low educational level to improve their access to physiotherapy services. Goals should aim towards the development of physical exercise programs to improve the patients' functional performance for a longer period.

Determinants of the use of physiotherapy services among individuals with Parkinson's disease living in Brazil / Determinantes do uso de serviço de fisioterapia entre indivíduos com doença de Parkinson que vivem no Brasil

ABSTRACT To identify the factors affecting the use of physiotherapy services among individuals with Parkinson's disease (PD) living in Brazil. Methods: Overall, 479 individuals with idiopathic PD, of both sexes, at any stage of the Hoehn & Yahr (HY) scale, and from seven capital cities in Brazil were recruited from 2014 to 2016. Multivariate logistic regression was the main statistical tool. For the construction of the logistic model, the association of the dependent variable "physiotherapy" with the independent sociodemographic/economic and clinical variables: age, education, family income, time of PD since onset, HY, the activities of daily living and motor subscales of the Unified Parkinson's Disease Rating Scale, cognitive aspects, depressive symptoms, fear of falling, freezing gait, history of falls, physical activity level, gait speed, walking performance and balance, were verified. Results: The 479 individuals had an average age of 65.2 ± 11.0 years, 88% were in the HY I-III stages and 43.4% were under physiotherapy treatment. The analysis identified two determinant variables related to the use of the physiotherapy service: level of education (OR = 1.24) and walking performance (OR = 0.82). Decreased walking performance and a higher educational level increased the use of a physiotherapy service in individuals with PD living in Brazil. Conclusions: The present study shows that individuals with PD, residents from different regions of Brazil, have limited access to physiotherapy services. In addition, the Brazilian Public Health Care System, as well as local programs, need to target PD individuals with a low educational level to improve their access to physiotherapy services. Goals should aim towards the development of physical exercise programs to improve the patients' functional performance for a longer period.

RESUMO Descrever a utilização do serviço de fisioterapia e identificar os fatores que determinam o uso desse serviço entre indivíduos com doença de Parkinson (DP) que vivem no Brasil. Métodos: No total, 479 indivíduos com DP idiopática, de ambos os sexos, em qualquer estágio da escala de Hoehn & Yahr (HY) e de sete capitais do Brasil foram recrutados durante 2014 a 2016. A análise de regressão logística multivariada foi a principal ferramenta de análise estatística. Para a construção do modelo logístico foi investigada a associação da variável dependente "fisioterapia" com variáveis independentes sociodemográficas, econômicas e clínicas: idade, educação, renda familiar, tempo de DP desde o início, HY, domínio motor e atividade de vida diária da Unified Parkinson´s Disease Rating Scale, aspectos cognitivos, sintomas depressivos, medo de queda, congelamento marcha, história de quedas, nível de atividade física, velocidade de marcha, capacidade de caminhar e equilíbrio. Resultados: 479 indivíduos apresentaram média de 65,2 ± 11,0 anos, 88% tiveram HY = I-III e 43,4% faziam fisioterapia para a DP. A análise identificou duas principais variáveis determinantes do uso da fisioterapia: educação (OR = 1,24) e capacidade de caminhada (OR = 0,82). A diminuição da capacidade de caminhar e maior nível educacional aumentam o uso da fisioterapia em indivíduos com doença de Parkinson vivendo no Brasil. Conclusões: O presente estudo mostra que indivíduos com DP, residentes de diferentes regiões do Brasil, têm acesso limitado aos serviços de fisioterapia. Além disso, o Sistema Brasileiro de Saúde Pública, bem como os programas locais, precisam atingir pessoas de DP com baixo nível educacional para melhorar seu acesso aos serviços de fisioterapia. Os objetivos devem ser para o desenvolvimento de programas de exercícios físicos para melhorar o desempenho funcional dos pacientes por um período mais longo.

Work and power reduced in L-dopa naïve patients in the early-stages of Parkinson's disease.

UNLABELLED: Studies which have investigated muscular performance during the initial stages of Parkinson's disease (PD) without L-dopa treatments were not found. OBJECTIVE: to assess whether muscular performance, work and power, of the trunk and lower limbs in L-dopa naïve patients in the early stages of PD was lower than those of healthy subjects and to compare muscular performance between the lower limbs. METHOD: Ten subjects with PD, Hoehn and Yahr (HY) I-II, L-dopa naïve and 10 subjects in the control group were assessed with the isokinetic dynamometer. RESULTS: ANOVAs revealed that work and power measures of the trunk, hip, knee, and ankle muscular groups were lower in PD compared with the control group (p < 0.05). There were no significant differences in muscular performance between the lower limbs. CONCLUSION: The results suggested the use of specific exercises, as rehabilitation strategies, to improve the ability to produce work and power with this population.

Work and power reduced in L-dopa naïve patients in the early-stages of Parkinson’s disease / Trabalho e potência reduzidos em indivíduos com doença de Parkinson sem L-dopa nos estágios iniciais

ABSTRACT Studies which have investigated muscular performance during the initial stages of Parkinson´s disease (PD) without L-dopa treatments were not found. Objective to assess whether muscular performance, work and power, of the trunk and lower limbs in L-dopa naïve patients in the early stages of PD was lower than those of healthy subjects and to compare muscular performance between the lower limbs. Method Ten subjects with PD, Hoehn and Yahr (HY) I-II, L-dopa naïve and 10 subjects in the control group were assessed with the isokinetic dynamometer. Results ANOVAs revealed that work and power measures of the trunk, hip, knee, and ankle muscular groups were lower in PD compared with the control group (p < 0.05). There were no significant differences in muscular performance between the lower limbs. Conclusion The results suggested the use of specific exercises, as rehabilitation strategies, to improve the ability to produce work and power with this population.

RESUMO Estudos que investigaram o desempenho muscular durante os estágios iniciais da doença de Parkinson (DP), sem tratamento com L-dopa não foram encontrados. Objetivo Avaliar se o desempenho muscular, por meio de medidas de trabalho e potência, do tronco e dos membros inferiores em pacientes sem o uso de L-dopa nas fases iniciais da DP é menor do que o de indivíduos saudáveis e comparar o desempenho muscular entre os membros inferiores. Método Dez indivíduos com DP, Hoehn and Yahr (HY) I-II, sem L-dopa e 10 indivíduos do grupo controle foram avaliados com o dinamômetro isocinético. Resultados Medidas de trabalho e potência muscular do tronco, quadril, joelho, tornozelo foram menores no PD em comparação com o grupo controle (p < 0,05) e não houve diferenças significativas no desempenho muscular entre os membros inferiores. Conclusão O uso de exercícios específicos, como estratégias de reabilitação, pode melhorar a capacidade de produzir trabalho e potência muscular nesta população.

Progressive resistance exercise improves strength and physical performance in people with mild to moderate Parkinson's disease: a systematic review.

QUESTION: Does progressive resistance exercise improve strength and measures of physical performance in people with Parkinson's disease? DESIGN: Systematic review with meta-analysis of randomised and quasi-randomised controlled trials. PARTICIPANTS: People with Parkinson's disease, regardless of gender or level of disability. INTERVENTION: Progressive resistance exercise, defined as involving repetitive, strong, or effortful muscle contractions and progression of load as the participant's abilities changed. OUTCOME MEASURES: Measures of muscle strength (maximum voluntary force production) - either continuous (force, torque, work, EMG) or ordinal (manual muscle test) - and physical performance measures: sit-to-stand time, fast and comfortable walking speeds, 6-min walk test, stair descent and ascent, the Activities-specific Balance Confidence scale, Timed Up and Go test, and the Short Physical Performance Battery. RESULTS: Four (quasi-) randomised trials were included, three of which reported data that could be pooled in a meta-analysis. Progressive resistance exercise increased strength, with a standardised mean difference 0.50 (95% CI 0.05 to 0.95), and had a clinically worthwhile effect on walking capacity, with a mean difference of 96 metres (95% CI 40 to 152) among people with mild to moderate Parkinson's disease. However, most physical performance outcomes did not show clinically worthwhile improvement after progressive resistance exercise. CONCLUSION: This review suggests that progressive resistance exercise can be effective and worthwhile in people with mild to moderate Parkinson's disease, but carryover of benefit does not occur for all measures of physical performance. The current evidence suggests that progressive resistance training should be implemented in Parkinson's disease rehabilitation, particularly when the aim is to improve walking capacity.

Redução do limite de estabilidade direção-específica em indivíduos leve a moderadamente afetados pela doença de Parkinson / Direction-specific limits of stability are reduced in mild to moderate Parkinson's disease individuals

A instabilidade postural na doença de Parkinson (DP) tem sido associada a uma diminuição do limite de estabilidade (LE) na direção ântero-posterior (AP). Entretanto, ainda que possíveis alterações do LE na direção látero-lateral (LL) tenham sido sugeridas, tal direção não tem sido avaliada nos estudos com DP, principalmente quando o teste de limite de estabilidade (TLE) envolve movimentos intencionais que deslocam o centro de massa corporal (CMC). O objetivo do presente estudo foi investigar o LE na postura de pé durante movimentos voluntários que promovem deslocamento do CMC nas direções AP e LL de indivíduos com e sem a DP. Doze indivíduos com DP (Hoehn & Yahr=II, III) e 12 sem a doença realizaram o TLE nos sentidos anterior, posterior, direito e esquerdo. A velocidade de movimento (VM), excursão máxima (EM) e o controle direcional (CD) do CMC foram avaliados em cada sentido. Os indivíduos com DP foram significativamente mais lentos em todos os sentidos de deslocamento do CMC (p<0,05). Não houve diferença significativa na EM e CD no sentido anterior entre os grupos (p>0,05). Por outro lado, a EM e CD do CMC foram menores para o grupo DP no sentido posterior (P) e na direção LL (p<0,05). Indivíduos leves a moderadamente afetados pela DP apresentaram redução do LE no sentido P e na direção LL quando comparados ao grupo controle. Os resultados sugerem que tal direção e sentido devam ser treinados em ortostatismo, com movimentos que deslocam voluntariamente o CMC, desde fases iniciais da DP.

Postural instability in Parkinson's disease (PD) has been associated with decreases of the limits of stability (LOS) in the anterior-posterior (AP) directions. Although LOS changes in the latero-lateral (LL) directions have been suggested, they have not been evaluated in studies with PD, especially when the LOS tests involve intentional displacements of the body center of mass (COM). The aim of this study was to investigate the LOS in standing posture during voluntary movements that promote movement of the COM in AP and LL directions of individuals with and without PD. Twelve subjects with PD (Hoehn & Yahr stages of II and III) and 12 without the disease performed the LOS tests in the anterior, posterior, right and left directions. The movement velocity (MV), maximum excursion (ME), and directional control (DC) of the COM were evaluated in all investigated directions. Individuals with PD demonstrated smaller COM displacements in all directions (p<0.05). There were no significant differences between the groups regarding the ME and DC in the anterior direction (p>0.05). However, the ME and DC of the COM were smaller for the PD group in the backward, right, and left directions (p<0.05). Individuals with mild to moderate PD demonstrated decreases in the LOS in the posterior and LL directions, when compared to individuals without the disease. These findings suggested that such directions should be trained in the standing position with voluntary movements of the COM from the early stages of PD.

Exercício aeróbio e fortalecimento muscular melhoram o desempenho funcional na doença de Parkinson / Aerobic exercise and muscular strengthening improve functional performance in Parkinson's disease

INTRODUÇÃO: Indivíduos com doença de Parkinson (DP) apresentam déficits motores na marcha, postura e equilíbrio e tendem a apresentar redução mais acentuada do nível de atividade física do que indivíduos assintomáticos da mesma idade. O declínio físico pode estar associado à perda de força muscular, da capacidade física e piora do desempenho funcional na DP. OBJETIVO: Avaliar os efeitos de um programa de fortalecimento e condicionamento aeróbio no desempenho funcional e na capacidade física de indivíduos com DP. MATERIAIS E MÉTODOS: Dezessete indivíduos, com média de idade de 60,35 ± 9,94 anos e estágios I a III da Hoehn e Yahr, participaram de um programa de exercícios três vezes por semana durante 12 semanas. Avaliou-se a força muscular por meio do dinamômetro manual, o desempenho funcional por meio da Unified Parkinson Disease Rating Scale (UPDRS), avaliou-se também a velocidade da marcha e habilidade em usar escadas e a capacidade física por meio do perfil de atividade humana (PAH). Utilizou-se a estatística descritiva, testes t e ANOVA para medidas repetidas para a análise. RESULTADOS E DISCUSSÃO: Os dorsoflexores bilaterais foram o único grupo muscular a apresentar maior torque após a intervenção (F = 7,93; p = 0,008). Houve ganho nas medidas de desempenho funcional: velocidade da marcha (p = 0,028), velocidade para subir (p = 0,001) e descer (p = 0,002) escadas, no escore total da UPDRS (p = 0,007) e do PAH (p < 0,0001). CONSIDERAÇÕES FINAIS: O uso combinado de condicionamento aeróbio e fortalecimento muscular resultou em melhoras no desempenho funcional e na capacidade física de indivíduos com DP leve a moderada.

INTRODUCTION: Individuals with Parkinson's disease (PD) show gait, posture, and balance deficits and, compared to asymptomatic individuals of similar ages, demonstrate more accentuated decreases in physical activity levels. These physical declines could be associated with losses of muscular strength, physical capacity, and functional performance. OBJECTIVES: To investigate the effects of a combined program of muscular strengthening and aerobic conditioning on functional performance and physical capacity of individuals with PD. MATERIALS AND METHODS: Seventeen PD volunteers, who had a mean age of 60.35 ± 9.94 years on the stages 1 to 3 on the Hoehn and Yahr scale, participated in the program conducted three times/week during 12 weeks. The following outcome measures were obtained before and after the program: muscular strength with the hand-held dynamometer, functional performance with the Unified Parkinson Disease Rating Scale (UPDRS), gait speed, ability to manage stairs, and physical capacity with the human activity profile (HAP). Descriptive statistics, t-tests, and repeated measure ANOVAS were employed for analyses. RESULTS AND DISCUSSION: The bilateral dorsal flexors were the only group which demonstrated significant increases in torque production after the intervention (F = 7.93; p = 0.008). However, significant gains were observed for all measures of functional performance: Gait speed (p = 0.028), stair ascent (p = 0.001), stair descent (p = 0.002), total UPDRS score (p = 0.007), and HAP score (p < 0.0001). CONCLUSIONS: The combined program of muscular strengthening and aerobic conditioning resulted in improvements in measures of functional performance and physical activity levels in individuals with PD in the early and moderate stages of the disease.