Reliability and Validity of Fall Efficacy Scale-International in People with Parkinson's Disease during On- and Off-Drug Phases

Studies in the Falls Efficacy Scale-International for patients with cervical compressive myelopathy: Reliability, validity, and minimum clinically important difference

CONTEXT

Patients with cervical compressive myelopathy (CCM) often complain of body balance problems, such as fear of falling and bodily unsteadiness. However, no accepted patient-reported outcome measures (PROMs) for this symptomatology exist. The Falls Efficacy Scale-International (FES-I) is one of the most widely used PROMs for evaluating impaired body balance in various clinical fields.

OBJECTIVE

To examine reliability, validity, and minimum clinically important difference (MCID) of the FES-I for the evaluation of impaired body balance in patients with CCM.

METHODS

Patients who underwent surgery for CCM were retrospectively reviewed. The FES-I was administered preoperatively and at 1 year postoperatively. Further, cJOA-LE score (subscore for lower extremities in the Japanese Orthopaedic Association score for cervical myelopathy) and stabilometric data, obtained at the same time points of the FES-I administration, were analyzed. Reliability was examined through internal consistency with Cronbach's alpha. Convergent validity was studied using correlation analysis. The MCID was estimated using anchor- and distribution-based methods.

RESULTS

Overall, 151 patients were included for analysis. Cronbach's alpha coefficient was the acceptable value of 0.97 at both baseline and 1 year postoperatively. As for convergent validity, the FES-I had significant correlations with the cJOA-LE score and stabilometric parameters both at baseline and 1 year postoperatively. The MCID calculated using anchor- and distribution-based methods was 5.5 and 10, respectively.

CONCLUSION

FES-I is a reliable and valid PROM to evaluate body balance problems for the CCM population. The established thresholds of MCID can help clinicians recognize the clinical significance of changes in patient status.

Effects of motor and cognitive complex training on obstacle walking and brain activity in people with Parkinson's disease: a randomized controlled trial

BACKGROUND

The difficulties in obstacle walking are significant in people with Parkinson's disease (PD) leading to an increased fall risk. Effective interventions to improve obstacle walking with possible training-related neuroplasticity changes are needed. We developed two different exercise programs, complex walking training and motor-cognitive training, both challenging motor and cognitive function for people with PD to improve obstacle walking.

AIM

To investigate the effects of these two novel training programs on obstacle walking and brain activities in PD.

DESIGN

A single-center randomized, single-blind controlled study.

SETTING

University laboratory; outpatient.

POPULATION

Individuals with idiopathic PD.

METHODS

Thirty-two participants were randomly assigned to the complex walking training group (N.=11), motor-cognitive training group (N.=11) or control group (N.=10). Participants in training groups received exercises for 40 minutes/session, with a total of 12-session over 6 weeks. Control group did not receive additional training. Primary outcomes included obstacle walking, and brain activities (prefrontal cortex (PFC), premotor cortex (PMC), and supplementary motor area (SMA)) during obstacle walking by using functional near-infrared spectroscopy. Secondary outcomes included obstacle crossing, timed up and go test (TUG), cognitive function in different domains, and fall efficacy scale (FES-I).

RESULTS

The motor-cognitive training group demonstrated greater improvements in obstacle walking speed and stride length, SMA activity, obstacle crossing velocity and stride length, digit span test, and TUG than the control group. The complex walking training did not show significant improvement in obstacle walking or change in brain activation compared with control group. However, the complex walking training resulted in greater improvements in Rey-Osterrieth Complex Figure test, TUG and FES-I compared with the control group.

CONCLUSIONS

Our 12-session of the cognitive-motor training improved obstacle walking performance with increased SMA activities in people with PD. However, the complex walking training did not lead such beneficial effects as the cognitive-motor training.

CLINICAL REHABILITATION IMPACT

The cognitive-motor training is suggested as an effective rehabilitation program to improve obstacle walking ability in individuals with PD.

Validity, reliability, and measurement error of the Japanese version of the Freezing of Gait Questionnaire for patients with Parkinson's disease

BACKGROUND

The Freezing of Gait Questionnaire has been translated into several languages. However, it has not been translated into Japanese and its measurement error remains unclear.Objectives: This study aimed to translate the Freezing of Gait Questionnaire into Japanese, investigate its validity and reliability, and calculate its measurement errors.

METHODS

Thirty-five patients with Parkinson's disease participated in the study. The Freezing of Gait Questionnaire was translated into Japanese using a forward - backward translation method. Convergent validity was assessed using the Freezing of Gait Questionnaire and Unified Parkinson's Disease Rating Scale Part II(item 14-freezing). The content validity index was calculated using the Freezing of Gait Questionnaire score using correlation coefficients. Internal consistency was measured using Cronbach's alpha. The test - retest reliability was evaluated using the intraclass correlation coefficient(1,1). The Bland - Altman analysis was performed to detect the limits of agreement.

RESULTS

The mean Freezing of Gait Questionnaire score was 9.1 (5.0) points. Convergent validity was 0.655 and content validity index was 0.958. Cronbach's alpha was 0.958, intraclass correlation coefficient(1,1) was 0.951, and the limits of agreement ranged from - 4.9 to3.2 points.

CONCLUSIONS

The Japanese version of the Freezing of Gait Questionnaire is a valid and useful tool to evaluate patients with Parkinson's disease.

Effects of Group Exercise on Motor Function and Mobility for Parkinson Disease: A Systematic Review and Meta-Analysis

OBJECTIVE

Parkinson disease (PD) is associated with a predictable decline in motor function and mobility that is commonly managed with exercise. There is a limited understanding of the effects of group exercise compared to individual exercise (IE) and usual care (UC) on motor function and mobility. Our purpose was to investigate the effects of group exercise compared to IE and UC on motor function and mobility for people with PD.

METHODS

A systematic review and meta-analysis was performed with randomized control trials that investigated the effects of group compared with IE and UC on motor function and mobility for people with PD. A systematic search was performed in PubMed, EBSCO, and Science Direct databases. Methodological quality was assessed using the Cochrane Grading of Recommendations Assessment, Development, and Evaluation approach.

RESULTS

Twenty-three studies assessed at least 1 mobility-related outcome measure, met our inclusion criteria, and were included in quantitative analysis. There was no significant difference on motor function and mobility between group exercise and IE for all standardized outcome assessment meta-analyses. Motor function and mobility were significantly improved with group exercise compared to UC in 9 of 11 standardized outcome assessment meta-analyses. Results were based upon low to moderate quality of evidence.

CONCLUSION

Based upon low to moderate quality of evidence, group exercise has a similar to larger effect as IE and UC on improving motor function and mobility for people with PD. When used in combination with skilled physical therapy, group exercise may be an appropriate adjunct to individualized physical therapy to maximize mobility and function.

IMPACT

Long-term adherence to exercise is essential to maintain mobility and motor function for people with PD. Our study suggests group exercise is as effective as IE and may be an appropriate option to encourage long-term adherence related to increased access, socialization, and accountability.

The effect of kinesiophobia on physical activity, balance, and fear of falling in patients with Parkinson's disease

PURPOSE

Kinesiophobia is defined as the fear of movement and activity resulting from a feeling of vulnerability to painful injury or re-injury. This study aimed to determine the effect of kinesiophobia on physical activity, balance, and fear of falling in patients with Parkinson's disease.

METHODS

The study, which was designed as a cross-sectional type, was conducted with 86 patients with Parkinson's disease (age 61.25 SD [9.72] years old) by face-to-face interviews with the patients. The Tampa Scale of Kinesiophobia, International Physical Activity Questionnaire-Short Form, Berg Balance Scale, Falls Efficacy Scale, Visual Analog Scale - Fear of Falling, Unified Parkinson's Disease Rating Scale - motor score, and the Hoehn and Yahr scale were used to evaluate the patients.

RESULTS

Patients with Parkinson's disease who had high levels of kinesiophobia had lower levels of physical activity, worse balance, and higher disease severity and fear of falling. A correlation was found between the Tampa Scale score and physical activity, balance, fear of falling, falls efficacy, and disease motor score (p < .001; r = -0.38, -0.54, 0.67, 0.57, and 0.37, respectively). According to multiple linear regression analysis, kinesiophobia explained the dependent variables to varying degrees ranging from 13% to 44% (p < .001).

CONCLUSIONS

Patients with Parkinson's disease may have kinesiophobia. Rehabilitation programs to support functional capacity for these patients should be developed considering the presence of kinesiophobia.

Associations between Muscle-Tendon Morphology and Functional Movements Capacity, Flexibility, and Balance in Older Women

Loss of functional movement capacity in older adults is related to adverse changes in musculotendinous morphology, but this relationship is poorly understood. This study examined the associations between musculotendinous morphology and functional movements, flexibility, and balance ability. Ninety-nine older women (66.6 ± 4.6 years, body mass index 23.5 ± 3.3 kg∙m−2) were recruited from Chonburi Province, Thailand. During one 90-min visit, muscle ultrasound imaging of vastus lateralis, biceps femoris, and medial gastrocnemius muscles, and tendon ultrasonography of the Achilles tendon and patellar tendon were performed. Measures were also obtained for the straight leg raise, passive dorsiflexion, balance, and functional tests (Five Times Sit to Stand (5TSTS), Timed Up and Go (TUG), 10-Meter Fast Walk Test (10-MFWT), and 6-Minute Walk Test (6-MWT)). The results specify that functional movement performance correlates most strongly with medial gastrocnemius muscle thickness (5TSTS (r = −0.26), TUG (r = −0.44), 10-MFWT (r = 0.41), and 6-MWT (r = 0.48) all p < 0.05) and that vastus lateralis muscle thickness and medial gastrocnemius muscle thickness correlate positively with balance ability (r = 0.24, 0.34; p < 0.05) and negatively with fear of falling. It appears that muscle mass, rather than other morphological parameters, such as muscle quality or fascicle length, is the main factor affecting the susceptibility of older women to frailty.

Clinical correlates of movement disorders in adult Niemann-Pick type C patients measured via a Personal KinetiGraph

Background

Niemann-Pick type C (NPC) is an autosomal recessive progressive neurodegenerative disorder caused by mutations in the NPC1 or NPC2 genes. Patients with this disorder have variable phenotypic presentations that often include neuropsychiatric manifestations, cognitive decline, and movement disorders. There is considerable interpatient variation in movement disorders, with limited quantitative measurements describing the movements observed. Objective measurements using wearable sensors provide clinically applicable monitoring of patients with Parkinson’s disease, and hence may be utilized in patients with NPC.

Objective

To explore the relationship between objective measurements of movement obtained via the use of the Personal KinetiGraph (PKG) with the clinical information obtained via questionnaires and clinical rating tools of patients with Niemann-Pick type C.

Methods

Twelve patients with Niemann-Pick type C were recruited who wore the PKG for 6 days during regular activities. A 6-day output was provided by the manufacturer, which provided bradykinesia (BK) and dyskinesia (DK) scores. BK and DK scores were further divided into their interquartile ranges. A fluctuation score (FDS), percentage time immobile (PTI), and percent time with tremors (PTT) were also provided. Clinical assessments included Abnormal Involuntary Movement Scale (AIMS), Epworth Sleepiness Score (ESS), Falls, Neuropsychiatric Unit Assessment Tool (NUCOG), Parkinson’s disease questionnaire (PDQ), and modified Unified Parkinson’s Disease Rating Scale (UPDRS) which were performed over telehealth within 2 weeks of PKG use. Pearson’s correlation analyses were utilized to explore the relationship between DK and BK quartiles and clinical measures.

Results

We found bradykinesia to be a feature among this cohort of patients, with a median BKS of 22.0 (7.4). Additionally, PTI scores were elevated at 4.9 (8.2) indicating elevated daytime sleepiness. Significant correlations were demonstrated between BK25 and Falls (r =  − 0.74, 95% CI = [− 0.95, − 0.08]), BK50 and Falls (r =  − 0.79, 95% CI = [− 0.96, − 0.19]), and BK75 and Falls (r =  − 0.76, 95% CI = [− 0.95, − 0.11]). FDS correlated with PDQ (r =  − 0.7, 95% CI = [− 0.92, − 0.18]), UPDRS IV (r =  − 0.65, 95% CI = [− 0.90, − 0.09]), UPDRS (r =  − 0.64, 95% CI = [− 0.9, − 0.06]), and AIMS (r =  − 0.96, 95% CI = [− 0.99, − 0.49]). DK25 in comparison with NUCOG-A (r = 0.72, 95% CI = [0.17, 0.93]) and DK75 in comparison with NUCOG (r = 0.64, 95% CI = [0.02, 0.91]) and NUCOG-A (r = 0.63, 95% CI = [0.01, 0.90]) demonstrated significant correlations. Additionally, duration of illness in comparison with PTI (r = 0.72, 95% CI = [0.22, 0.92]) demonstrated significance.

Conclusions

Utilization of PKG measures demonstrated that bradykinesia is under recognized among NPC patients, and the bradykinetic patients were less likely to report concerns regarding falls. Additionally, the FDS rather than the DKS is sensitive to the abnormal involuntary movements of NPC—reflecting a differing neurobiology of this chorea compared to levodopa-induced dyskinesias. Furthermore, dyskinetic individuals performed better in cognitive assessments of attention which may indicate an earlier timepoint within disease progression.

Effect of Neurofeedback Training on Aggression and Impulsivity in Children With Attention-Deficit/Hyperactivity Disorder: A Double-Blinded Randomized Controlled Trial

Introduction

Aggression and impulsivity are some of the behavioral symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD). Neurofeedback (NF) training has been suggested as a promising treatment in these children. This study aimed to investigate the effect of NF training on aggression and impulsivity in schoolchildren with ADHD.

Methods

A total of 40 male elementary school children with ADHD (aged 11.17±0.97 years) were randomized into the NF and sham groups. The NF group received 12 NF training sessions, each taking about 60 minutes for six consecutive weeks (twice a week), based on the Hammond protocol. The subjects' parents were questioned to evaluate the outcomes, including aggression and impulsivity, using the Buss-Perry Aggression Questionnaire (BPAQ) and Barratt Impulsiveness Scale (BIS).

Results

After the intervention, in the NF group, the BPAQ score changed from 87.60±9.33 to 81±7.23 and the BIS score from 94.7±7.25 to 88.05±5.4, which were significant (P=0.001). The results indicated the large effect size of NF on aggression and impulsivity in ADHD.

Conclusion

Our findings suggest NF training as a clinically applicable method for decreasing aggression and impulsivity, also support concurrent use of medication and NF training in children with ADHD.

The correlation between fear of falling and upper extremity muscle strength

Objectives:

To determine the relationship between fear of falling (FOF) and upper extremity muscle strength.

Methods:

This cross-sectional study included 112 hospitalized, mobile patients. Forty-seven (42%) were males and 65 (58%) were females, and the mean age was 72.3. The study was carried out between September 2018 and September 2019 at Balikli Rum Hospital Nursing Homes, Istanbul, Turkey. Patients were tested using geriatric tools (such as Mini-Mental State Examination) and physical tests such as handgrip, key pinch and 6-meter up and go tests.

Results:

The average annual falling number of elderly people with FOF was statistically significantly higher than that in those without FOF (p=0.001). Right handgrip, left handgrip, right key pinch, and left key-pinch mean values in elderly individuals with FOF were statistically significantly lower than those without FOF (p< 0.001, p< 0.001, p< 0.001, p< 0.001, respectively).

Conclusion:

The measurement of upper extremity strength could be a predicting parameter of FOF.

Motor control times and strategies in left- and right-handed participants: Behavioral evidence for the hemispheric distribution of motor planning

Background: There is conflicting evidence in favor of the hemispheric distribution of motor planning. Some studies supported the left-hemisphere-dominance hypothesis for motor planning and claimed that the left-hemisphere has a crucial function in motor control even in left-handers. The present study aimed to compare the right- and left-handed participants on motor planning ability and to investigate the performance of their dominant hands in a specific action selection task. Also, the effect of task complexity was assessed. Methods: Twenty right-handers and 20 left-handers performed an action selection task. The participants had to grasp a hexagonal knob with their dominant hand and consequently rotated it 60° or 180 ° clockwise or counterclockwise. Depending on our objects, we used mixed factorial ANOVA and the groups were examined in terms of the planning time, grasping time, releasing time and planning pattern for initial grip selection. The SPSS 19 was used for analyzing the data and p≤0.05 was considered as the significant level. Results: No significant differences were observed between the two groups. The movement-related measures revealed a main effect of rotation (p˂0.001). However, a significant interaction between direction × planning pattern × group (p˂0.001) indicated a preferential bias for rotatory movements in the medial direction which is consistent with the "medial over lateral advantage". Conclusion: Both left- and right-handed participants had a similar motor planning ability while performing a planning task with their dominant hands. Because our study was behavioral, it only provided a test of the left-hemisphere hypothesis of motor planning.

Fear of Falling Among Community-Dwelling Older Adults with Heart Disease: Findings from an International Mobility in Aging Study (IMIAS)

Background: Older adults with heart disease (HD) are more likely to report a higher prevalence of falls compared to those without HD. A knowledge gap currently exists regarding the factors associated with fear of falling (FOF) among older adults with HD. Therefore, this study aimed to estimate FOF and identify factors associated with FOF among older adults with HD. Methods: Data came from a secondary analysis of the International Mobility in Aging Study (IMIAS) baseline (2012) data. FOF was measured using the Falls Efficacy Scale-International (FES-I). Stepwise linear regression was used to identify factors associated with FOF. Results: A total of 429 participants identified themselves as having heart disease diagnosed by their physician (mean age 69.5 ± 2.9). Older adults with HD reported on average (25.6) higher FOF than those without HD. For older adults with HD, FES-I increased significantly by 1.3, 1.0, and 0.6 points, when the Short Physical Performance Battery, the Leganes Cognitive Test, and QOL total scores decreased by one point. FES-I also significantly increased by 3.2 when income was insufficient compared to sufficient or very sufficient income. Discussion: FOF is multifactorial, and our findings provide a base for developing future management rehabilitation intervention programs aimed at decreasing FOF among older adults with HD.

Effects of a power strength training using elastic resistance exercises on the motor and non-motor symptoms in patients with Parkinson's disease H&Y 1-3: study protocol for a randomised controlled trial (PARK-BAND Study)

INTRODUCTION

Parkinson's disease (PD) is the second most common neurodegenerative disorder in Brazil. Physical activity is a complementary intervention in managing inherent declines associated with the disease like strength, balance, gait, and functionality and benefit health-related outcomes. Here, we report the PARK-BAND Study protocol, which aims to investigate potential benefits of power training using elastic devices in participants with PD. Our intervention will be provided in patients with PD using elastic devices like elastic bands and tubes. Therefore, we used the term Park from Parkinson's disease and band from elastic bands.

METHODS AND ANALYSIS

This randomised single-blind single-centre two-arm parallel, superiority trial will include 50 participants with PD attending the clinical setting. Those who meet the eligibility criteria and provide consent to participate will be randomised in a 1:1 ratio to either the exercise group, which will receive power training programme or the health education group, which will receive the education programme. Randomisation will be performed by permuted block randomisation with a block size of eight. Both groups will receive a 12-week intervention. The exercise group will have two sessions per week and the health education group will have one session per week. Changes from baseline in bradykinesia, as assessed by the Unified Parkinson's Disease Rating Scale motor examination subscore and physical functional performance, will be the primary outcomes. Secondary outcomes include other neurological, neurophysiological and physical variables, as well as the quality of life, depression, cognition, sleep quality and disturbances, assessed before and after interventions. We hypothesise that the exercise group will have greater improvement in primary and secondary outcomes than the health education group.

ETHICS AND DISSEMINATION

The study is approved by the Research Ethics Committee of Hospital Universitário Walter Cantidio and all participants will provide their written informed consent (register number 91075318.1.0000.5045).Trial results will be disseminated via peer reviewed journal articles and conference presentations, reports for organisations involved with PD and for participants.

TRIAL REGISTRATION NUMBER

Registro Brasileiro de Ensaios Clínicos Registry (RBR-5w2sqt); Pre-results.

Effects of Vestibular Rehabilitation on Fatigue and Activities of Daily Living in People with Parkinson's Disease: A Pilot Randomized Controlled Trial Study

One of the most disabling nonmotor symptoms in persons with Parkinson's disease is fatigue, which can decrease the quality of life by restricting the function and activities of daily living (ADL). Nonetheless, sufficient evidence for treating fatigue, including drug or nondrug treatment, is not available. In this study, we evaluated the probable effects of vestibular rehabilitation on fatigue and ADL in patients with Parkinson's disease. Methods. This was a single-blind clinical trial study in which patients with Parkinson's disease voluntarily participated based on the inclusion and exclusion criteria. The patients were randomly assigned to the case and control groups. The case group received 24 sessions of vestibular rehabilitation protocol, and conventional rehabilitation was performed in the control group (i.e., 3 sessions each week, each lasted about 60 minutes). Both groups were also given fatigue management advice. Fatigue was measured by the Parkinson Fatigue Scale (PFS) and the Modified Fatigue Impact Scale (MFIS). ADL was measured by the Functional Independence Measure (FIM). All changes were measured from the baseline at the completion of the intervention. Results. Both fatigue (P ≤ 0.001) and ADL (P ≤ 0.001) improved significantly more in the vestibular intervention group than in the control one. Conclusion. Vestibular rehabilitation may improve fatigue and ADL and therefore can be used as an effective intervention for patients with Parkinson's disease, which was also found to be well tolerated.

Melatonin and dopamine serum level associations with motor, cognitive, and sleep dysfunctions in patients with Parkinson's disease: A cross-sectional research study

BACKGROUND

Parkinson's disease (PD) is a multisystem-progressive neurodegenerative disease characterized by dopaminergic neurons, however, the role of the non-dopaminergic system (such as melatonin hormone) in the pathogenesis of PD is now emerging.

OBJECTIVE

To identify any potential correlation between the dopamine and melatonin serum levels, and motor, cognitive, and sleep dysfunctions in patients with PD.

METHOD

Cross-sectional piloting study conducted with a sample of 34 patients with PD (aged 50-72 yrs old). Correlation tests performed to identify any potential correlations between the biomarkers' serum levels and motor, cognitive, and sleep dysfunctional levels in "on-medication" status.

RESULTS

Spearman's test showed significant correlations between the melatonin serum level and sleep dysfunctions including overall sleep quality (P = 0.010) and subjective sleep quality sub-score (P = 0.001). On the other hand, spearman's test showed significant correlations between the dopamine serum level and motor dysfunctions including Berg Balance Scale (P = 0.026), 10-Meter Walk Test (P = 0.016), and Fear of Falling Index (P = 0.007), as well as comparisons between the dopamine serum level and cognitive dysfunction (P = 0.048).

CONCLUSIONS

Melatonin serum level would serve as a potential biomarker in understanding the PD pathogenesis, and the melatonin serum level should be considered in future studies related to PD besides the dopamine serum level.

Measures of balance and falls risk prediction in people with Parkinson's disease: a systematic review of psychometric properties

OBJECTIVE

To investigate the psychometric properties of measures of balance and falls risk prediction in people with Parkinson's disease (PD).

DATA SOURCES

PubMed, Embase, CINAHL, Ovid Medline, Scopus, and Web of Science were searched from inception to August 2019.

REVIEW METHOD

Studies testing psychometric properties of measures of balance and falls risk prediction in PD were included. The four-point COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) assessed quality.

RESULTS

Eighty studies testing 68 outcome measures were reviewed; 43 measures assessed balance, 9 assessed falls risk prediction, and 16 assessed both. The measures with robust psychometric estimation with acceptable properties were the (1) Mini-Balance Evaluation Systems Test (Mini-BEST), (2) Berg Balance Scale, (3) Timed Up and Go test, (4) Falls Efficacy Scale International, and (5) Activities-Specific Balance Confidence scale. These measures assess balance and falls risk prediction at the body, structure and function level, falls risk and balance, and falls risk at the activity level. The motor examination of the Unified Parkinson's Disease Rating Scale (UPDRS-ME) with robust psychometric analysis is a condition-specific measure with acceptable properties. Except the UPDRS-ME and Mini-BESTest, the responsiveness of the other four measures has yet to be established.

CONCLUSION

Six of the 68 outcome measures have strong psychometric properties for the assessment of balance and falls risk prediction in PD. Measures assessing balance and falls risk prediction at the participatory level are limited in number with a lack of psychometric validation.