Abstract
The shuffling gait with slowed speed and reduced stride length has been considered classic clinical features in idiopathic Parkinson’s disease (PD), and the risk of falling increases as the disease progresses. This raises the possibility that clinical disease severity might mediate the relationship between stride length and speed and the risk of falling in patients with PD. Sixty-one patients with PD patients underwent the clinical scores as well as quantitative biomechanical measures during walking cycles before and after dopamine replacement therapy. Mediation analysis tests whether the direct effect of an independent variable (stride length and speed) on a dependent variable (three-step fall prediction model score) can be explained by the indirect influence of the mediating variable (Unified Parkinson’s Disease Rating Scale (UPDRS) total scores). The results demonstrate that decreased stride length, straight walking speed, and turning speed is associated with increased three-step fall prediction model score (r = −0.583, p < 0.0001, r = −0.519, p < 0.0001, and r = −0.462, p < 0.0001, respectively). We further discovered that UPDRS total scores value is negatively correlated with stride length, straight walking, and turning speed (r = −0.651, p < 0.0001, r = −0.555, p < 0.0001, and r = −0.372, p = 0.005, respectively) but positively correlated with the fall prediction model score value (r = 0.527, p < 0.0001). Further mediation analysis shows that the UPDRS total score values serve as mediators between lower stride length, straight walking, and turning speed and higher fall prediction model score values. Our results highlighted the relationship among stride length and speed, clinical disease severity, and risk of falling. As decreased stride length and speed are hallmarks of falls, monitoring the changes of quantitative biomechanical measures along with the use of wearable technology in a longitudinal study can provide a scientific basis for pharmacology, rehabilitation programs, and selecting high-risk candidates for surgical treatment to reduce future fall risk.
Highlights
Falls in people with idiopathic Parkinson’s disease (PD) have multifactorial causation [1], but gait disturbance is a major contributor
The results revealed that Unified Parkinson’s Disease Rating Scale (UPDRS) total score and stride length (m) during the ‘off’ stage was significantly associated with the three-step fall prediction model score (Table 6)
Our study demonstrated that speed (m/s), stride and step length (m), step length variability, and total hip range of motion (ROM) significantly increased after dopamine replacement therapy
Summary
Falls in people with idiopathic Parkinson’s disease (PD) have multifactorial causation [1], but gait disturbance is a major contributor. It can present from the early stages of the disease [2], and increased fall risk is the most debilitating symptom in patients with PD. The three-step fall prediction test is a valid and reliable scale for clinical fall risk prediction tools in PD [10]. The assessment of clinical scales for PD is mostly completed through brief observations made during patient visits, and it can be subjective and affected by the examiner’s experience. Frequent clinic visits increase the physical and economic burden of patients and their families [11]
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