ABSTRACT
Background: Postural instability is a debilitating cardinal symptom of Parkinson's disease (PD). Its onset marks a pivotal milestone in PD when balance impairment results in disability in many activities of daily living. Early detection of postural instability by non-expensive tools that can be widely used in clinical practice is a key factor in the prevention of falls in widespread population and their negative consequences. Objective: This study aimed to investigate the effectiveness of a two-dimensional balance assessment to identify the decline in postural control associated with PD progression. Methods: This study recruited 55 people with PD, of which 37 were men. Eleven participants were in stage I, twenty-three in stage II, and twenty-one in stage III. According to the Hoehn and Yahr (H&Y) rating scale, three clinical balance tests (Timed Up and Go test, Balance Evaluation Systems Test, and Push and Release test) were carried out in addition to a static stance test recorded by a two-dimensional movement analysis software. Based on kinematic variables generated by the software, a Postural Instability Index (PII) was created, allowing a comparison between its results and those obtained by clinical tests. Results: There were differences between sociodemographic variables directly related to PD evolution. Although all tests were correlated with H&Y stages, only the PII was able to differentiate the first three stages of disease evolution (H&Y I and II: p = 0.03; H&Y I and III: p = 0.00001; H&Y II and III: p = 0.02). Other clinical tests were able to differentiate only people in the moderate PD stage (H&Y III). Conclusion: Based on the PII index, it was possible to differentiate the postural control decline among the first three stages of PD evolution. This study offers a promising possibility of a low-cost, early identification of subtle changes in postural control in people with PD in clinical practice.
ABSTRACT
Background: Gait is one of the activities most affected by the symptoms of Parkinson's disease and may show a linear decline as the disease progresses. Early assessment of its performance through clinically relevant tests is a key factor in designing efficient therapeutic plans and procedures, which can be enhanced using simple and low-cost technological instruments. Objective: To investigate the effectiveness of a two-dimensional gait assessment to identify the decline in gait performance associated with Parkinson's disease progression. Methods: One hundred and seventeen people with Parkinson's disease, classified between early and intermediate stages, performed three clinical gait tests (Timed Up and Go, Dynamic Gait Index, and item 29 of the Unified Parkinson's Disease Rating Scale), in addition to a six-meter gait test recorded by a two-dimensional movement analysis software. Based on variables generated by the software, a gait performance index was created, allowing a comparison between its results with the results obtained by clinical tests. Results: There were differences between sociodemographic variables directly related to the evolution of Parkinson's disease. Compared to clinical tests, the index proposed to analyze gait showed greater sensitivity and was able to differentiate the first three stages of disease evolution (Hoehn and Yahr I and II: p = 0.03; Hoehn and Yahr I and III: p = 0.00001; Hoehn and Yahr II and III: p = 0.02). Conclusion: Based on the index provided by a two-dimensional movement analysis software that uses kinematic gait variables, it was possible to differentiate the gait performance decline among the three first stages of Parkinson's disease evolution. This study offers a promising possibility of early identification of subtle changes in an essential function of people with Parkinson's disease.
ABSTRACT
ABSTRACTBACKGROUND AND OBJECTIVES:Chronic pain affects thousands of people, changing their functionality and emotional status. The Brief Pain Inventory has not been used in populational studies and may be a relevant tool. This study aimed at characterizing chronic pain sensory aspects and their influence on daily life activities.METHODS:This is a cross-sectional populational study carried out in a Family Health Unit (Salvador/BA/Brazil). Participated in the study 191 individuals aged 20 years or above, with pain for six months or longer. Brief Pain Inventory was used as evaluation tool because it has sensory aspects as predicting variables and reactive aspects as outcome variables. Chi-square test was used for proportional analysis and Spearman correlation test was used for intergroup comparisons.RESULTS:Sample was made up of 86.4% females, single (48.7%), non white (49.7%), low education (46.6%) and low socio-economic level (100.0%). Most participants (46.8%) have reported pain for at least five years, with predominance of knees (46.1%) and lumbar spine (42.4%), being that 77.5% of the population made systematic use of some painkiller. There has been negative correlation between sensory and reactive variables: general activities (p<0.001; r=0.482), mood (p<0.001; r=0.396), walking ability (p<0.001; r=0.318) and working ability (p<0.001; r=0.389). There has been no correlation for the ability of enjoying life (p=0.403; r=0.061).CONCLUSION:In a low socio-economic level population, chronic pain primarily affects knees and lumbar spine with negative interference on general activities, mood, walking and working ability.
RESUMOJUSTIFICATIVA E OBJETIVOS:A dor crônica afeta milhares de pessoas, mudando sua funcionalidade e estado emocional. O Inventário Breve de Dor não tem sido utilizado em estudos populacionais e pode representar uma ferramenta relevante. O objetivo deste estudo foi caracterizar aspectos sensoriais da dor crônica e sua influência nas atividades diárias.MÉTODOS:Estudo transversal populacional realizado em Unidade de Saúde da Família (Salvador/BA/Brasil). Foram incluídos 191 indivíduos com idade entre 20 anos ou mais, com queixa de dor por um período igual ou superior a seis meses. O Inventário Breve de Dor foi utilizado como um instrumento de avaliação que tem os aspectos sensoriais como variáveis previsoras, e os aspectos reativos como variáveis de desfecho. Foi utilizado o teste qui-quadrado para análise proporcional e correlação de Spearman para a comparação intergrupo.RESULTADOS:A amostra foi composta por 86,4% de mulheres, solteiros (48,7%), não brancos (49,7%), baixa escolaridade (46,6%) e baixo nível socioeconômico (100,0%). A maioria (46,8%) descreveu dor por período no mínimo de cinco anos, com predominância em joelhos (46,1%) e coluna lombar (42,4%). Setenta e sete e meio por cento da população faz uso sistemático de algum fármaco para dor. Encontrou-se correlação negativa entre as variáveis sensoriais com variáveis reativas: atividades gerais (p<0,001; r=0,482), humor (p<0,001; r=0,396), capacidade de caminhar (p<0,001; r=0,318) e capacidade de trabalho (p<0,001; r=0,389). Não houve correlação para a capacidade de apreciar a vida (p=0,403; r=0,061).CONCLUSÃO:Em uma população de baixo nível socioeconômico, a dor crônica afeta especialmente os joelhos e a coluna lombar com interferência negativa nas atividades gerais, humor, capacidade de andar e trabalhar.
