Mobility device use in people with Parkinson's disease: A 3-year follow-up study

Effects of using conventional assistive devices on spatiotemporal gait parameters of adults with neurological disorders: A systematic review protocol

Individuals with neurological disorders often experience gait impairments that contribute to increased disability, long-term care risk, and higher healthcare costs. The prescription of assistive devices is a commonly employed strategy to compensate for gait impairments in this population. Despite being recommended by various guidelines, there are limited recommendations for prescribing these devices. Furthermore, the effects of using assistive devices on the gait of individuals with neurological disorders are poorly known. Therefore, the aim of this systematic review is to investigate the immediate, short, and long-term effects of using conventional assistive devices (e.g., canes, crutches, walkers) on gait parameters of adults with neurological disorders. This Systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (registration number: CRD42024542695) and was conducted following Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Experimental studies that investigated the effects of using conventional assistive devices on the gait of individuals with neurological disorders will be included. Electronic searches will be conducted in Medical Literature Analysis and Retrieval System Online (MEDLINE Ovid), Excerpta Medica Database (Embase Classic +  Embase Ovid), Physiotherapy Evidence Database (PEDro), Scientific Electronic Library Online (Scielo), Cumulative Index to Nursing and Allied Health Literature (CINAHL Database), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) and gray literature. The reference lists of the included studies will be manually searched. Two trained independent reviewers will select the studies, extract the data, and assess the methodological quality of the included studies using the Cochrane Risk of Bias tools. Disagreements between reviewers will be solved through consensus or by a third independent reviewer. The quality of the evidence will be assessed (GRADE). If a sufficient number of comparable studies are available, subgroup analysis will be conducted and we will consider doing a meta-analysis if the studies are homogeneous. The review will be reported following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA 2020 statement). The results of this review will provide useful information about the effects of assistive devices on gait in different neurological disorders comprehensively and systematically. Investigating the immediate, short and long-term effects may generate useful information for making clinical decisions related to the training time for using these devices. If a meta-analysis is possible, the prescription of these devices could be improved based on knowledge of their effects. Finally, the results of this systematic review will identify gaps in the literature and guide future research.

Structure and process of Parkinson's disease rehabilitation in the southern sector of Ghana: A cross-sectional survey

RATIONALE

The structure, process and outcome (SPO) framework has been used to establish that improved structures of care influences an enhanced process of stroke care resulting in improved outcome. Although, both stroke and Parkinson's disease (PD) are neurological conditions that require prolonged period of care and rehabilitation, the SPO framework has not yet been used to describe the existing structures and processes of PD care and rehabilitation in Ghana.

AIMS AND OBJECTIVE

To describe the current structures and processes of PD rehabilitation across the three healthcare levels (primary, secondary and tertiary) in the southern sector of Ghana.

METHOD

An online cross-sectional descriptive survey design was used via REDCap. Fifty-two therapists, including department heads, physiotherapists, occupational therapists and speech and language therapists from seven healthcare facilities were purposefully sampled and invited to complete the survey on structures and processes of PD rehabilitation. Descriptive statistical analysis was performed with SPSS v29.0. Comparative analysis was performed using Pearson's chi-square and Kruskal-Wallis test (H-test) as appropriate. Statistical significance was set at p < 0.05.

RESULTS

Forty-nine (94.2%) responses were received and four incomplete responses were excluded from analysis. Structure of rehabilitation: Most of the participants were physiotherapists (n = 36/45; 80.0%) and tertiary level professionals (n = 31/45; 68.9%). Only physiotherapy service was available across all the healthcare levels. Persons with PD were mostly referred for rehabilitation at Hoehn and Yahr stage III as reported by 55.6% (n = 20/36) of the therapists. Process of rehabilitation: Most therapists treated persons with PD two times weekly (n = 19/33; 57.6%) and on individual basis (n = 29/33; 87.9%). Only 9 (27.2%) and 7 (21.2%) therapists often used clinical guidelines or outcome measures respectively in managing PD and 93.9% of the therapists had no local protocols.

CONCLUSION

The structures and processes needed for PD rehabilitation exist but differ across the healthcare levels and among therapists. Physiotherapy was the most common rehabilitation service available at all levels of healthcare.

Management of freezing of gait - mechanism-based practical recommendations

Freezing of gait (FOG) is a debilitating motor symptom that commonly occurs in Parkinson disease, atypical parkinsonism and other neurodegenerative conditions. Management of FOG is complex and requires a multifaceted approach that includes pharmacological, surgical and non-pharmacological interventions. In this Expert Recommendation, we provide state-of-the-art practical recommendations for the management of FOG, based on the latest insights into the pathophysiology of the condition. We propose two complementary treatment flows, both of which are linked to the pathophysiology and tailored to specific FOG phenotypes. The first workflow focuses on the reduction of excessive inhibitory outflow from the basal ganglia through use of dopaminergic medication or advanced therapies such as deep brain stimulation and infusion therapy. The second workflow focuses on facilitation of processing across cerebral compensatory networks by use of non-pharmacological interventions. We also highlight interventions that have potential for FOG but are not supported by sufficient evidence to recommend for clinical application. Our updated recommendations are intended to enable effective symptomatic relief once FOG has developed, but we also consider potential targets for preventive approaches. The recommendations are based on scientific evidence where available, supplemented with practice-based evidence informed by our clinical experience.

Promoting active aging through assistive product design innovation: a preference-based integrated design framework

Background

With the accelerating trend of global aging, over one billion people need to use one or more types of assistive products. However, the high abandonment rate of current assistive products is affecting the quality of life of the older adults, posing challenges to public health. Accurately capturing the preference factors of the older adults in the design process is an important way to improve the acceptance of assistive products. In addition, a systematic approach is needed to translate these preference factors into innovative product solutions. These two issues are less addressed in existing research.

Methods

First, the evaluation grid method was used to conduct in-depth interviews with users and extract the structure of preference factors for assistive products. Quantification theory type I was used to calculate the weight of each factor. Secondly, universal design principles, TRIZ theory's contradiction analysis techniques, and invention principles were used to translate the preference factors into design guidelines. Then, finite structure method (FSM), morphological chart, and CAD techniques were used to visualize the design guidelines as alternatives. Finally, Analytic Hierarchy Process (AHP) was used to evaluate and rank the alternatives.

Results

A Preference-based Assistive Product Design Model (PAPDM) was proposed. The model includes three stages: definition, ideation, and evaluation. A case study on walking aid demonstrated the execution of PAPDM. The results show that 28 preference factors influence the four psychological needs of the older adults: sense of security, sense of independence, self-esteem, and sense of participation. These psychological needs were reflected in the shape, color, material, universality, user-friendly, reliability, and smart functions of assistive products. The preference factors were transformed into five design guidelines, and three alternatives were generated. Finally, the evaluation concludes that solution C was the optimal solution.

Conclusion

The PAPDM framework provides designers with a transparent, progressive approach to designing assistive products that meet unique needs and preferences of older adults. This enhances objectivity and scientific rigor in assistive product development, avoiding blind design and production. By considering the perspective of older adults from the outset, we can avoid high abandonment rates of assistive products and contribute to promoting active aging.

Effects of a rollator on fall prevention in Community-Dwelling people with Parkinson's Disease: A prospective cohort study

Introduction

This study aimed to investigate the effect of a rollator on the prevention of falls in patients with Parkinson's disease (PD) during outdoor walks.

Method

This study examined 30 community-dwelling patients with PD. Factors associated with falls were classified into clinical patient background, physical function, and psychophysiological function factors. The number of falls and subsequent injuries was observed over a period of greater than 6 months, if patients were using rollators while falls happened.

Results

Participants who used a rollator had a significantly lower fall rate, number of falls, and injury rate than those who did not use a rollator (p < 0.05).

Conclusion

A rollator could protect patients with PD from falls. Additionally, when considering the use of a rollator for patients with PD, it is important to assess the patient's physical and psychophysiological functions.

Environmental barriers and housing accessibility problems for people with Parkinson's disease: A three-year perspective

BACKGROUND

Although housing accessibility is associated with important health outcomes in other populations, few studies have addressed this in a Parkinson's disease population.

AIM

To determine the most severe environmental barriers in terms of housing accessibility problems and how these evolved over 3 years among people with Parkinson's disease.

MATERIAL AND METHODS

138 participants were included (men = 67%; mean age = 68 years). The most severe environmental barrier were identified by the Housing Enabler instrument and ranked in descending order. The paired t-test was used to analyse changes in accessibility problems over time.

RESULTS

The top 10 barriers remained largely unchanged over 3 years, but with notable changes in order and magnitude. 'No grab bar in hygiene area' and 'Stairs only route' were top-ranked in generating accessibility problems at baseline but decreased significantly (p = 0.041; p = 0.002) at follow-up. 'Difficulties to reach refuse bin' was top-ranked at follow-up, with a significant increase (p < 0.001) of related accessibility problems.

CONCLUSIONS AND SIGNIFICANCE

The new knowledge about how accessibility problems evolve over time could be used by occupational therapists to recommend more effective housing adaptations taking the progressive nature of Parkinson's disease into account. On societal level, the results could be used to address accessibility problems systematically.

Predictive Factors of Fall-Related Activity Avoidance in People With Parkinson Disease-A Longitudinal Study With a 3-Year Follow-up

BACKGROUND AND PURPOSE

Knowledge of predictive factors can foster the development of preventive approaches. This study examined how prevalence and severity of fall-related activity avoidance evolve over a 3-year period in people with Parkinson disease (PD). A specific aim was to identify predictive factors of fall-related activity avoidance (ie, modified Survey of Activities and Fear of Falling in the Elderly [mSAFFE] scores) after 3 years.

METHODS

The sample included 151 people with PD (mean [SD] age: 68 [8.8] years). The mSAFFE score was the dependent variable in multivariable linear regression analyses, with 17 potential predictors. On the basis of a collinearity check, 2 models studying various risk factors were developed. Model 1 included concerns about falling and model 2 walking difficulties.

RESULTS

After 3 years, more participants reported fall-related activity avoidance, that is, 34% versus 50% (P < 0.001). Regression model 1 explained 63% of the variance. The strongest predictive factor was concerns about falling (standardized regression coefficient, β = 0.589), followed by pain (β = 0.161), unsteadiness while turning (β = 0.137), and age (β = 0.136). These variables remained significant when adjusting for mSAFFE baseline scores.In model 2 (explained 50% of the variance), the strongest predictive factor was perceived walking difficulties (β = 0.392), followed by age (β = 0.238), unsteadiness while turning (β = 0.198), and pain (β = 0.184). Unlike the other factors, walking difficulties were not significant when adjusting for mSAFFE baseline scores.

DISCUSSION AND CONCLUSIONS

Fall-related activity avoidance increased over time in people with PD. If fall-related activity avoidance is to be targeted, this study suggests that interventions should address concerns about falling, pain, unsteadiness while turning, and walking difficulties.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A310).

Impact of disease stage and age at Parkinson's onset on patients' primary concerns: Insights for targeted management

Background

The concerns of people with Parkinson’s disease (PD) about their disease are often different from the objective clinical picture and subject to various influencing factors, including disease progression. Currently our understanding of these concerns is limited, particularly in Asian countries.

Methods

A 50-item survey on Parkinson’s Disease Patients’ Concerns (PDPC Survey) was developed by a multidisciplinary care team. The subjective greatest concerns (most commonly concerning symptoms) of patients at a specialist centre in Bangkok, Thailand, were explored and categorised according to disease stage and age at onset of PD.

Results

Data for 222 patients showed concerns varied widely. Motor symptoms giving the greatest concern were problems with walking and/or balance (40.5% of patients), while the most commonly concerning non-motor symptom (NMS) was constipation (41.0%). Patterns were observed amongst different patient subgroups. Early PD patients (H&Y stage 1) were more concerned about NMS than motor symptoms, while the reverse was true for advanced PD patients. Young-onset PD patients showed significantly greater concerns than typical-onset patients about motor symptoms relating to social functioning, working and stigmatisation, such as speech (p = 0.003).

Conclusions

This study, in an Asian patient cohort, provides an assessment of a wide range of PD patients’ concerns, encompassing not only motor symptoms and NMS, but also treatment-related adverse events, care in the advanced stage, and the need for assistive devices. Identifying the concerns of individual PD patients and implementing a patient-centred approach to care is critical to their wellbeing and optimal outcomes. The PDPC survey can help healthcare teams build a more accurate picture of patients’ experiences to inform clinical management.

Prediction of Life Satisfaction in People with Parkinson's Disease

Introduction

People with Parkinson's disease (PD) have lower life satisfaction (LS) than healthy peers. No study has yet identified predictors of LS in people with PD. Such information would be valuable for health care and future interventions that aim to maintain or increase LS.

Aim

To examine how LS evolved in people with PD over a 3-year period, as well as to identify predictive factors of LS.

Methods

We used data from baseline assessments and a 3-year follow-up of 163 people with PD (baseline, mean age 68 years; median PD duration 8 years, 35% women). LS was assessed with item 1 of the Life Satisfaction Questionnaire (LiSat-11). Dichotomized LS data from the 3-year follow-up were used as the dependent variable in multivariable logistic regression analyses. In the first step, independent variables included baseline information on sex, education, general self-efficacy, motor symptoms, perceived walking difficulties, fall-related activity avoidance, and difficulties with/need help in activities of daily living. At the second step, depressive symptoms were added as an independent variable.

Results

The proportion of those who reported being satisfied with their lives reduced from 63.2% at baseline to 49.7% 3 years later (p=0.003). When depressive symptoms were not included in the analysis, general self-efficacy (odds ratio, OR = 1.081; 95% CI = 1.019–1.147) and perceived walking difficulties (OR = 0.962; 95% CI = 0.929–0.997) were significant (p < 0.05) predictors of LS 3 years later. With depressive symptoms included, the influence of walking difficulties diminished, and depressive symptoms (OR = 0.730; 95% CI = 0.607–0.877) and general self-efficacy (OR = 1.074; 95% CI = 1.010–1.142) were the only significant predictors of LS 3 years later.

Conclusions

LS is reduced over a 3-year period. The study suggests that perceived walking difficulties, general self-efficacy, and depressive symptoms are important predictors of LS in people with PD.

Longitudinal association between housing accessibility and activities of daily living: the role of self-efficacy and control in people ageing with Parkinson's disease

Background

External housing-related control beliefs (HCB) and general self-efficacy (GSE) influence different health outcomes in the general ageing population, but there is no information of their role in people ageing with Parkinson’s disease (PD). This study aimed to longitudinally assess the role of external HCB and GSE on the association between housing accessibility and activities of daily living (ADL) among people ageing with PD.

Methods

Baseline and 3-year follow-up data on 130 community-living participants from the Swedish project ‘Home and Health in People Ageing with PD’ were collected. Assessments addressed housing accessibility, external HCB, GSE, generic ADL and ADL specific to PD. The moderating effects of external HCB and GSE were assessed by including an interaction term in multivariable logistic regression.

Results

There were statistically significant interactions between housing accessibility and GSE on ADL (p = 0.03), and housing accessibility and external HCB on PD specific ADL (p = 0.03). After stratifying the analyses by GSE, housing accessibility problems led to more dependence and difficulty in ADL in participants with low GSE (OR 1.14; 95% CI 1.02–1.28). After stratifying by external HCB, housing accessibility increased dependence and difficulty in PD specific ADL in participants with low external HCB (OR 1.35; 95% CI 1.03–1.76).

Discussion

The results suggest that housing accessibility predicts ADL in people with PD with GSE and external HCB playing a moderating role for generic ADL and ADL specific to PD, respectively. Further longitudinal studies should validate these findings and explore their potential application in PD-related care and rehabilitation.

Predictive Factors of Concerns about Falling in People with Parkinson's Disease: A 3-Year Longitudinal Study

Introduction

Fear of falling (FOF) is more common in people with Parkinson's disease (PD) than in healthy controls. It can lead to several negative consequences such as restrictions in everyday life. Moreover, FOF is a risk factor for future falls.

Aim

This study aimed to identify predictive factors of FOF (conceptualized as concerns about falling) after three years, with and without adjusting for concerns about falling at baseline, in people with PD.

Methods

This study included 151 participants (35% women) with PD. At baseline, their mean (SD) age and PD duration were 68 (±9.0) and 9 (±6.1) years, respectively. The Falls Efficacy Scale-International (FES-I) was used as the dependent variable in multivariable linear regression analyses.

Results

The mean (SD) FES-I score increased from 28.1 (11.9) to 33.1 (14.0) three years later (p < 0.001). The strongest (according to the standardized regression coefficient, β) predictor of concerns about falling was walking difficulties (β = 0.378), followed by age (0.227), problems maintaining balance while dual tasking (0.172), and needing help in daily activities (0.171). When adjusting for baseline FES-I scores, the strongest predictive factor was problems maintaining balance while dual tasking (β = 0.161), which was followed by age (0.131) and female sex (0.105).

Conclusions

This study pinpoints several predictive factors of concerns about falling that are modifiable and which could be addressed in rehabilitation: perceived walking difficulties, having problems maintaining balance while dual tasking, and dependence on others in daily activities. The importance of dual tasking is a novel finding, which future studies need to confirm or refute. One should be aware of the fact that an increased age predicts concerns about falling with and without adjusting for baseline FES-I scores, whereas female sex predicts concerns about falling only when adjusting for baseline FES-I scores.

Psychosocial impact of mobility assistive technology on people with neurological conditions

INTRODUCTION

A wide range of products are available to assist mobility, and it is, therefore, of great importance to obtain empirical information regarding the expected impact of the use of these products based on outcome measures. People affected by neurological disorders often use products to assist mobility such as wheelchairs (both manual self-propelled wheelchairs and externally propelled chairs such as electric wheelchairs), walkers, walking sticks, etc. It is important to conduct an assessment of the psychosocial impact of these products on the lives of affected people.

METHODS

We performed this assessment using the Psychosocial Impact of Assistive Devices Scale (PIADS) and a socio-demographic questionnaire.

RESULTS

The results showed greater psychosocial benefits relating to the use of electric wheelchairs in comparison with walking sticks or manual, non-self-propelled chairs. Moreover, significant differences are present in the three subscales of the PIADS in relation to variables such as age, training in the use of assistive technology (AT) and funding.

CONCLUSION

Therefore, we conclude that the use of AT should be promoted among this group as a way to improve their adaptability, competency and self-esteem, and to reduce limits on participation deriving from the physical and contextual barriers faced by this collective.Implications for rehabilitationAmong the assessment of different mobility AT displaying a higher score in the three subscales of the PIADS amongst people using electric wheelchairs than among those using non-self-propelled manual wheelchairs. On the other hand, we found that the walker has a significant score only in the competence subscale. Canes, for example the stick 4-p is significant in the three subscales, or the walking cane in terms of competence. Despite the fact that crutches and walking sticks obtained the lowest score in this study.Not only the assessment is necessary, but also the adjustment of AT to the person who is going to use it, as well as some training on how to use it. Only 23.8% of the participants received training in the use of their main assistive device in this study.The results seem to indicate that for elder users, the score on adaptability with the AT is lower. That may result in future lines of research in usability and improving in terms of the needs of end-users and these AT since a high percentage of people with neurological conditions are elder people.The application of specific scales such as PIADS that helps to measure the use and capacity of the AT prescribed to patients with neurological disease provides more informed clinical reasoning.