Motor Performance Assessment in Parkinson's Disease: Association between Objective In-Clinic, Objective In-Home, and Subjective/Semi-Objective Measures.

Jane Mohler,Saman Parvaneh,Nima Toosizadeh,Walter Maetzler,Scott Sherman,Hong Lei,Bijan Najafi

doi:10.1371/journal.pone.0124763

Abstract

Advances in wearable technology allow for the objective assessment of motor performance in both in-home and in-clinic environments and were used to explore motor impairments in Parkinson’s disease (PD). The aims of this study were to: 1) assess differences between in-clinic and in-home gait speed, and sit-to-stand and stand-to-sit duration in PD patients (in comparison with healthy controls); and 2) determine the objective physical activity measures, including gait, postural balance, instrumented Timed-up-and-go (iTUG), and in-home spontaneous physical activity (SPA), with the highest correlation with subjective/semi-objective measures, including health survey, fall history (fallers vs. non-fallers), fear of falling, pain, Unified Parkinson's Disease Rating Scale, and PD stage (Hoehn and Yahr). Objective assessments of motor performance were made by measuring physical activities in the same sample of PD patients (n = 15, Age: 71.2±6.3 years) and age-matched healthy controls (n = 35, Age: 71.9±3.8 years). The association between in-clinic and in-home parameters, and between objective parameters and subjective/semi-objective evaluations in the PD group was assessed using linear regression-analysis of variance models and reported as Pearson correlations (R). Both in-home SPA and in-clinic assessments demonstrated strong discriminatory power in detecting impaired motor function in PD. However, mean effect size (0.94±0.37) for in-home measures was smaller compared to in-clinic assessments (1.30±0.34) for parameters that were significantly different between PD and healthy groups. No significant correlation was observed between identical in-clinic and in-home parameters in the PD group (R = 0.10–0.25; p>0.40), while the healthy showed stronger correlation in gait speed, sit-to-stand duration, and stand-to-sit duration (R = 0.36–0.56; p<0.03). This suggests a better correlation between supervised and unsupervised motor function assessments in healthy controls compared to PD group. In the PD group, parameters related to velocity and range-of-motion of lower extremity within gait assessment (R = 0.58–0.84), and turning duration and velocity within iTUG test (R = 0.62–0.77) demonstrated strong correlations with PD stage (p<0.01).

Highlights

Parkinson’s disease (PD) is the second most common neurodegenerative disease after Alzheimer’s disease, with over 60,000 new diagnoses each year in the United States alone [1]
We explored the association between the severity of PD and motor impairments using the above objective measures, correlating objective parameters and subjective and semi-objective evaluations (e.g., Unified Parkinson's Disease Rating Scale (UPDRS) and the Hoehn and Yahr (H&Y) disease stage)
Differences between in-clinic and in-home assessment of motor impairment in PD. Both within- and between-subjects variability in motor performance measures were different between in-home and in-clinic assessments, especially in the PD group

Summary

Introduction

Parkinson’s disease (PD) is the second most common neurodegenerative disease after Alzheimer’s disease, with over 60,000 new diagnoses each year in the United States alone [1]. Several objective outcomes of motor impairment have been previously introduced to explore differences between healthy controls and PD patients, as well as pre- and post-treatment changes in PD conditions, including gait analysis [3], postural balance performance [4,5], Timed-up-and-go (TUG) [6], and spontaneous physical activity (SPA) [7,8]. A new sensor-based instrumented TUG (iTUG) method, which includes spatio-temporal parameters during turning, standing, and sitting, demonstrated more sensitivity in differentiating between PD patients and healthy controls [6]. By using wearable sensors, the differences in SPA parameters, such as gait speed, transitions from sit-to-stand and stand-to-sit, and the number and duration of walking episodes have been quantified between PD patients and healthy controls [7,8]

Methods

Results

Conclusion