Abstract
Background: Postural abnormalities in Parkinson's disease (PD) form a spectrum of functional trunk misalignment, ranging from a “typical” parkinsonian stooped posture to progressively greater degrees of spine deviation.Objective: To analyze the association between degree of postural abnormalities and disability and to determine cut-off values of trunk bending associated with limitations in activities of daily living (ADLs), motor impairment, falls, and back pain.Methods: The study population was 283 PD patients with ≥5° of forward trunk bending (FTB), lateral trunk bending (LTB) or forward neck bending (FNB). The degrees were calculated using a wall goniometer (WG) and software-based measurements (SBM). Logistic regression models were used to identify the degree of bending associated with moderate/severe limitation in ADLs (Movement Disorders Society Unified PD Rating Scale [MDS-UPDRS] part II ≥17), moderate/severe motor impairment (MDS-UPDRS part III ≥33), history of falls (≥1), and moderate/severe back pain intensity (numeric rating scale ≥4). The optimal cut-off was identified using receiver operating characteristic (ROC) curves.Results: We found significant associations between modified Hoehn & Yahr stage, disease duration, sex, and limitation in ADLs, motor impairment, back pain intensity, and history of falls. Degree of trunk bending was associated only with motor impairment in LTB (odds ratio [OR] 1.12; 95% confidence interval [CI], 1.03–1.22). ROC curves showed that patients with LTB of 10.5° (SBM, AUC 0.626) may have moderate/severe motor impairment.Conclusions: The severity of trunk misalignment does not fully explain limitation in ADLs, motor impairment, falls, and back pain. Multiple factors possibly related to an aggressive PD phenotype may account for disability in PD patients with FTB, LTB, and FNB.
Highlights
Postural abnormalities are common features of Parkinson’s disease (PD) and manifest in over 20% of patients during the course of disease [1]
A total of 283 PD patients were enrolled according to the inclusion and exclusion criteria
The adjusted odds ratios showed a significant association between motor impairment and degree of lateral trunk bending (LTB), indicating that an increase in lateral bending increases the probability of greater motor impairment
Summary
Postural abnormalities are common features of Parkinson’s disease (PD) and manifest in over 20% of patients during the course of disease [1]. PD-associated postural abnormalities form a spectrum of functional trunk misalignment, ranging from a “typical” parkinsonian stooped posture, with rounding of the shoulders and flexion of the hips and knees, to progressively greater degrees of trunk bending. Given the lack of a common and comprehensive classification for postural abnormalities and the still unexplored impact of “milder” trunk flexion on disability, there is a rationale for revision of the classification of PD-associated postural abnormalities: [1] criteria for CC, PS, and AC have been decided a priori based on observational judgment of movement disorder experts and are not anchored to any formal measure of activities of daily living (ADLs), motor impairment, risk of falls or pain; and [2] the current cut-offs refer to very severe conditions, leaving many PD patients with potentially disabling postural abnormalities without an effective diagnosis of postural abnormalities. Postural abnormalities in Parkinson’s disease (PD) form a spectrum of functional trunk misalignment, ranging from a “typical” parkinsonian stooped posture to progressively greater degrees of spine deviation
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