Determinants of objectively measured physical functional performance in early to mid-stage Parkinson disease.

BACKGROUND: Parkinson disease (PD) may lead to functional limitations through both motor and nonmotor symptoms. Although patients with advanced disease have well-documented and profound functional limitations, less is known about the determinants of function in early to mid-stage disease where interventions may be more likely to benefit and preserve function. OBJECTIVE: The objective of the current study was to identify motor, cognitive, and gait determinants of physical functional performance in patients with early to mid-stage PD. DESIGN: This was a secondary analysis of cross-sectional baseline data from a randomized clinical trial of exercise. SETTING: The study was performed at a tertiary academic medical center. PARTICIPANTS: The study included 121 patients with early to mid-stage PD. METHODS: Our functional performance outcomes included the following: the Continuous Scale Physical Functional Performance Test (CS-PFP; primary outcome); the Timed Up and Go test (TUG); and Section 2 (Activities of Daily Living) of the Unified Parkinson's Disease Rating Scale (UPDRS). Explanatory variables included measures of disease severity, motor function, cognitive function, balance, and gait. Stepwise linear regression models were used to determine correlations between explanatory variables and outcome measures. RESULTS: In our regression models, the CS-PFP significantly correlated with walking endurance (Six-Minute Walk Test; r(2) = 0.12, P < .0001), turning ability (360° Turn Test; r(2) = 0.03, P = .002), attention (Brief Test of Attention; r(2) = 0.01, P = .03), overall cognitive status (Mini-Mental State Examination; r(2) = 0.01, P = .04), and bradykinesia (timed tapping; r(2) = 0.02, P = .02). The TUG significantly correlated with walking speed (5-Meter Walk Test; r(2) = 0.33, P < .0001), stride length (r(2) = 0.25, P < .0001), turning ability (360° turn, r(2) = 0.05, P = .0003), and attention (r(2) = 0.016, P = .03). Section 2 of the UPDRS was significantly correlated with endurance (r(2) = 0.09, P < .0001), turning ability (r(2) = 0.03, P = .001), and attention (r(2) = 0.01, P = .03). CONCLUSIONS: Gait, motor, and cognitive function all contribute to objectively measured global functional ability in mild to moderate PD. Subjectively measured functional activity outcomes may underestimate the impact of both motor and nonmotor symptoms.

Does prior acupuncture exposure affect perception of blinded real or sham acupuncture?

OBJECTIVE: To determine if acupuncture-exposed and naïve participants differ in their perceptions of real and sham acupuncture under blinded conditions. METHODS: The setting was an outpatient clinic at the Colorado School of Traditional Chinese Medicine. Participants were between the ages of 18 and 90 years. Acupuncture-exposed participants had at least five prior acupuncture treatments, with one treatment in the month prior to the study date. Acupuncture-naïve participants had experienced no prior acupuncture treatments. Participants with dementia, cognitive impairment, or neuropathy were excluded. In total, 61 acupuncture-exposed and 59 acupuncture-naïve participants were blindfolded and received either real acupuncture or toothpick sham acupuncture treatment. Following treatment, participants completed a questionnaire rating the realness of the acupuncture and were asked how they made this determination. We used a previously developed scale rating treatments from 1 (definitely real needle) to 5 (definitely imitation needle) to assess outcome. RESULTS: Perceptions of the real treatment were rated as more real than sham treatments for all participants. Further analysis revealed that prior acupuncture exposure did not influence ratings of real treatments, but exposed participants rated sham treatments as significantly less real than naïve participants. CONCLUSIONS: Acupuncture-naïve and exposed participants both reported different perceptions of real and sham acupuncture using a blindfolded toothpick protocol. This suggests that future trials should carefully monitor participant perceptions of treatments received, even for naïve individuals. Differences between groups further suggest that participants with significant and/or recent exposure to real acupuncture may introduce bias to blinded clinical acupuncture trials.