Are functional mobility tests responsive to group physical therapy intervention in individuals with Parkinson's disease?

BACKGROUND: The Timed up and go test (TUG), the Five times sit-to-stand test (FTSTS) and the Bed Mobility test (BMT) are widely used in clinical practice for Parkinson Disease (PD). However, no reported studies have evaluated the responsiveness to group physical therapy intervention (GPTI). OBJECTIVE: To verify if TUG, FTSTS and BMT were responsive to GPTI. METHODS: Thirty individuals with PD were assessed prior to and after an 8-week evidence-based GPTI. Paired t test was used to determine statistically significant change pre-and post-intervention. Internal responsiveness (IR) was classified with the standardized response mean (SRM). A 5-point Likert scale assessed self-perceived performance by the subjects after the intervention. Analysis of the receiver operating characteristic (ROC) curve was used to determine the accuracy and cut-off scores for identifying participants who had shown improvement. RESULTS: GPTI was efficient in improving real (p≤0.001) and self-perceived mobility performance in all measures. All tests were responsive to changes: the IR varied from medium to high (SRM = 0.7-1.5); the cut-off point for TUG test was >2.2 s, for FTSTS test was >2.5 s and for BM test >1.4 s. CONCLUSIONS: The TUG, FTSTS and BMT were responsive to the GPTI and accurately detected meaningful clinical changes. Our results provide an important information about the clinical application of these tests in PD individuals.

Cross cultural adaptations and psychometric domains of Brazilian version of PROFILE PD for Parkinson's disease.

PURPOSE: The PROFILE PD scale was developed specifically to evaluate patients with Parkinson's disease (PD) within the context of the International Classification of Functioning, Disability and Health, directly applied to physical therapy practice. The study aimed to translate and cross-culturally adapt the PROFILE PD scale to Portuguese-Brazil, and to analyze its psychometric domains. METHODS: Fifty participants with PD participated in the study. We assessed the clarity of the Brazilian version of the scale by physiotherapists, presence of floor and ceiling effects, interrater and test-retest reliabilities, in addition to discriminant, concurrent (UPDRS) and construct validity, internal consistence, minimal detectable change (MDC), and responsiveness. RESULTS: The scale was considered highly clear for physical therapists. The interrater ICC was 0.74 and Wk was 0.89 for the total score. For test-retest reliability, the total ICC score was 0.99. The analysis of concurrent validity showed the Spearman correlation between Brazilian version of PROFILE PD and UPDRS (ρ = 0.77; p < 0.001). Factor analyses demonstrated that the test comprises a single scale. Brazilian version of PROFILE PD was able to discriminate the subject with PD in mild and moderate stages, and in mild and severe stages. A high internal consistency was found (α = 0.99). MDC was 2.41 points and there were no floor and ceiling effects. Also, the scale was responsive to physical therapy intervention, with improvement in 8 points after two months (effect size = 0.85). CONCLUSION: The Brazilian version of PROFILE PD is an instrument reliable, valid, and responsive to physical therapy intervention, that can be used to quantify impairments and limitations in patients with PD and can provide an overall summary of the impact of disease, useful for physiotherapy practice. Implications for Rehabilitation PROFILE PD is a reliable and valid instrument to be applied in Brazilian Parkinson disease patients. This scale is design specially to be used in physical therapy practice within the contexts surrounding the International Classification of Functioning, Disability and Health. PROFILE PD was able to discriminate between patients in mild and moderate stages of disease which is difficult in clinical practice mainly because the scale used for this relies on balance and gait rather than a global profile.