Hubble Ryan P, Naughton Geraldine A, Silburn Peter A, Cole Michael H
School of Exercise Science, Australian Catholic University, Brisbane, Queensland, Australia.
School of Exercise Science, Australian Catholic University, Melbourne, Victoria, Australia.
PLoS One. 2015 Apr 20;10(4):e0123705. doi: 10.1371/journal.pone.0123705. eCollection 2015.
Postural instability and gait disability threaten the independence and well-being of people with Parkinson's disease and increase the risk of falls and fall-related injuries. Prospective research has shown that commonly-used clinical assessments of balance and walking lack the sensitivity to accurately and consistently identify those people with Parkinson's disease who are at a higher risk of falling. Wearable sensors provide a portable and affordable alternative for researchers and clinicians who are seeking to objectively assess movements and falls risk in the clinical setting. However, no consensus currently exists on the optimal placements for sensors and the best outcome measures to use for assessing standing balance and walking stability in Parkinson's disease patients. Hence, this systematic review aimed to examine the available literature to establish the best sensor types, locations and outcomes to assess standing balance and walking stability in this population.
Papers listed in three electronic databases were searched by title and abstract to identify articles measuring standing balance or walking stability with any kind of wearable sensor among adults diagnosed with PD. To be eligible for inclusion, papers were required to be full-text articles published in English between January 1994 and December 2014 that assessed measures of standing balance or walking stability with wearable sensors in people with PD. Articles were excluded if they; i) did not use any form of wearable sensor to measure variables associated with standing balance or walking stability; ii) did not include a control group or control condition; iii) were an abstract and/or included in the proceedings of a conference; or iv) were a review article or case study. The targeted search of the three electronic databases identified 340 articles that were potentially eligible for inclusion, but following title, abstract and full-text review only 26 articles were deemed to meet the inclusion criteria. Included articles were assessed for methodological quality and relevant data from the papers were extracted and synthesized.
Quality assessment of these included articles indicated that 31% were of low methodological quality, while 58% were of moderate methodological quality and 11% were of high methodological quality. All studies adopted a cross-sectional design and used a variety of sensor types and outcome measures to assess standing balance or walking stability in people with Parkinson's disease. Despite the typically low to moderate methodological quality, 81% of the studies reported differences in sensor-based measures of standing balance or walking stability between different groups of Parkinson's disease patients and/or healthy controls.
These data support the use of wearable sensors for detecting differences in standing balance and walking stability between people with PD and controls. Further high-quality research is needed to better understand the utility of wearable sensors for the early identification of Parkinson's disease symptoms and for assessing falls risk in this population.
CRD42014010838.
姿势不稳和步态障碍威胁着帕金森病患者的独立性和健康状况，并增加了跌倒及跌倒相关损伤的风险。前瞻性研究表明，常用的平衡和行走临床评估方法缺乏敏感性，无法准确且一致地识别出帕金森病患者中跌倒风险较高的人群。对于寻求在临床环境中客观评估运动和跌倒风险的研究人员和临床医生而言，可穿戴传感器提供了一种便携且经济实惠的替代方案。然而，目前对于传感器的最佳放置位置以及用于评估帕金森病患者站立平衡和行走稳定性的最佳结果测量方法尚无共识。因此，本系统评价旨在审视现有文献，以确定用于评估该人群站立平衡和行走稳定性的最佳传感器类型、位置及结果测量方法。
通过标题和摘要搜索三个电子数据库中列出的论文，以识别在被诊断为帕金森病的成年人中使用任何类型可穿戴传感器测量站立平衡或行走稳定性的文章。要符合纳入标准，论文必须是1994年1月至2014年12月期间以英文发表的全文文章，且评估了帕金森病患者使用可穿戴传感器进行站立平衡或行走稳定性的测量。若文章存在以下情况则被排除：i）未使用任何形式的可穿戴传感器测量与站立平衡或行走稳定性相关的变量；ii）未包括对照组或对照条件；iii）为摘要和/或包含在会议论文集中；或iv）为综述文章或案例研究。对三个电子数据库的定向搜索共识别出340篇可能符合纳入标准的文章，但经过标题、摘要和全文评审后，仅有26篇文章被认为符合纳入标准。对纳入的文章进行方法学质量评估，并提取和综合论文中的相关数据。
对这些纳入文章的质量评估表明，31%的文章方法学质量较低，58%的文章方法学质量中等，11%的文章方法学质量较高。所有研究均采用横断面设计，并使用了多种传感器类型和结果测量方法来评估帕金森病患者的站立平衡或行走稳定性。尽管方法学质量通常较低至中等，但81%的研究报告了不同组帕金森病患者和/或健康对照之间基于传感器的站立平衡或行走稳定性测量存在差异。
这些数据支持使用可穿戴传感器来检测帕金森病患者与对照组之间站立平衡和行走稳定性的差异。需要进一步开展高质量研究，以更好地了解可穿戴传感器在早期识别帕金森病症状及评估该人群跌倒风险方面的效用。
PROSPERO注册编号：CRD42014010838
