title: Investigation of factors impacting mobility and gait in Parkinson disease.
abstract: Mobility and gait limitations are major issues for people with Parkinson disease (PD). Identification of factors that contribute to these impairments may inform treatment and intervention strategies. In this study we investigated factors that predict mobility and gait impairment in PD. Participants with mild to moderate PD and without dementia (n=114) were tested in one session 'off' medication. Mobility measures included the 6-Minute Walk test and Timed-Up-and-Go. Gait velocity was collected in four conditions: forward preferred speed, forward dual task, forward fast as possible and backward walking. The predictors analyzed were age, gender, disease severity, balance, balance confidence, fall history, self-reported physical activity, and executive function. Multiple regression models were used to assess the relationships between predictors and outcomes. The predictors, in different combinations for each outcome measure, explained 55.7% to 66.9% of variability for mobility and 39.5% to 52.8% for gait velocity. Balance was the most relevant factor (explaining up to 54.1% of variance in mobility and up to 45.6% in gait velocity). Balance confidence contributed to a lesser extent (2.0% to 8.2% of variance) in all models. Age explained a small percentage of variance in mobility and gait velocity (up to 2.9%). Executive function explained 3.0% of variance during forward walking only. The strong predictive relationships between balance deficits and mobility and gait impairment suggest targeting balance deficits may be particularly important for improving mobility and gait in people with PD, regardless of an individual's age, disease severity, fall history, or other demographic features.
authors.affiliation: Federal University of Mato Grosso do Sul, Program in Health and Development, Campo Grande, MS 79060-900, Brazil; Washington University School of Medicine in Saint Louis, Program in Physical Therapy, St. Louis, MO 63108, USA.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Christofoletti
authors.affiliation: Washington University School of Medicine in Saint Louis, Program in Physical Therapy, St. Louis, MO 63108, USA; Washington University School of Medicine in Saint Louis, Department of Neurology, St. Louis, MO 63110, USA.
authors.forename: Marie E
authors.initials: ME
authors.lastname: McNeely
authors.affiliation: Washington University School of Medicine in Saint Louis, Department of Neurology, St. Louis, MO 63110, USA; Washington University School of Medicine in Saint Louis, Department of Radiology, St. Louis, MO 63110, USA.
authors.forename: Meghan C
authors.initials: MC
authors.lastname: Campbell
authors.affiliation: Washington University School of Medicine in Saint Louis, Program in Physical Therapy, St. Louis, MO 63108, USA; Washington University School of Medicine in Saint Louis, Department of Neurology, St. Louis, MO 63110, USA.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Duncan
authors.affiliation: Washington University School of Medicine in Saint Louis, Program in Physical Therapy, St. Louis, MO 63108, USA; Washington University School of Medicine in Saint Louis, Department of Neurology, St. Louis, MO 63110, USA; Washington University School of Medicine in Saint Louis, Department of Neuroscience, St. Louis, MO 63110, USA. Electronic address: earhartg@wustl.edu.
authors.forename: Gammon M
authors.initials: GM
authors.lastname: Earhart
mesh_terms: D000058:Accidental Falls; D000367:Age Factors; D000368:Aged; D004185:Disability Evaluation; D056344:Executive Function / Q000502:physiology; D005260:Female; D005684:Gait / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D010300:Parkinson Disease / Q000175:diagnosis / Q000503:physiopathology*; D004856:Postural Balance / Q000502:physiology*; D016138:Walking / Q000502:physiology*
keywords: Balance; Disease severity; Executive function; Gait; Mobility; Parkinson disease