帕金森病中的屈曲躯干姿势：测量可靠性及其与身体和认知障碍、活动能力和平衡的关系

Flexed Truncal Posture in Parkinson Disease: Measurement Reliability and Relationship With Physical and Cognitive Impairments, Mobility, and Balance.

作者信息

Forsyth Aimi L, Paul Serene S, Allen Natalie E, Sherrington Catherine, Fung Victor S C, Canning Colleen G

机构信息

Faculty of Health Sciences, The University of Sydney, Sydney, Australia (A.L.F., S.S.P., N.E.A., C.G.C.); Musculoskeletal Division, The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, Australia (S.S.P., C.S.); Movement Disorders Unit, Department of Neurology, Westmead Hospital, Sydney, Australia (V.S.C.F.); Sydney Medical School, The University of Sydney, Sydney, Australia (V.S.C.F.); and Department of Physical Therapy, University of Utah, Salt Lake City, United States of America (S.S.P.).

出版信息

J Neurol Phys Ther. 2017 Apr;41(2):107-113. doi: 10.1097/NPT.0000000000000171.

DOI:10.1097/NPT.0000000000000171

PMID:28263252

Abstract

BACKGROUND AND PURPOSE

Flexed truncal posture is common in people with Parkinson disease (PD); however, little is known about the mechanisms responsible or its effect on physical performance. This cross-sectional study aimed to establish the reliability of a truncal posture measurement and explore relationships between PD impairments and truncal posture, as well as truncal posture and balance and mobility.

METHODS

A total of 82 people with PD participated. Truncal posture was measured in standing as the distance between vertebra C7 and a wall. Univariate and multivariate regression analyses were performed with truncal posture and impairments, including global axial symptoms, tremor, bradykinesia, rigidity, freezing of gait (FOG), reactive stepping and executive function, as well as truncal posture with balance and mobility measures.

RESULTS

The truncal posture measure had excellent test-retest reliability (ICC3,1 0.79, 95% CI 0.60-0.89, P < 0.001). Global axial symptoms had the strongest association with truncal posture (adjusted R = 0.08, P = 0.01), although the majority of the variance remains unexplained. Post hoc analysis revealed that several impairments were associated with truncal posture only in those who did not report FOG. Flexed truncal posture was associated with poorer performance of most balance and mobility tasks after adjustment for age, gender, disease severity, and duration (adjusted R = 0.24-0.33, P < 0.001-0.03).

DISCUSSION AND CONCLUSIONS

The C7 to wall measurement is highly reliable in people with PD. Global axial symptoms were independently associated with truncal posture. Greater flexed truncal posture was associated with poorer balance and mobility. Further studies are required to elucidate the mechanisms responsible for flexed truncal posture and the impact on activity.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A164).

摘要

背景与目的

帕金森病（PD）患者中屈曲躯干姿势很常见；然而，对于其产生机制或对身体功能的影响知之甚少。这项横断面研究旨在确定躯干姿势测量的可靠性，并探讨PD损伤与躯干姿势之间的关系，以及躯干姿势与平衡和活动能力之间的关系。

方法

共有82名PD患者参与。站立时测量躯干姿势，即第7颈椎与墙壁之间的距离。对躯干姿势与包括全身轴向症状、震颤、运动迟缓、僵硬、步态冻结（FOG）、反应性步幅和执行功能等损伤进行单变量和多变量回归分析，以及对躯干姿势与平衡和活动能力测量进行分析。

结果

躯干姿势测量具有出色的重测可靠性（组内相关系数ICC3,1为0.79，95%可信区间为0.60 - 0.89，P < 0.001）。全身轴向症状与躯干姿势的关联最强（调整后的R = 0.08，P = 0.01），尽管大部分变异仍无法解释。事后分析显示，仅在未报告FOG的患者中，几种损伤与躯干姿势相关。在对年龄、性别、疾病严重程度和病程进行调整后，屈曲的躯干姿势与大多数平衡和活动能力任务的较差表现相关（调整后的R = 0.24 - 0.33，P < 0.001 - 0.03）。

讨论与结论

在PD患者中，第7颈椎到墙壁的测量高度可靠。全身轴向症状与躯干姿势独立相关。更大程度的屈曲躯干姿势与较差的平衡和活动能力相关。需要进一步研究以阐明屈曲躯干姿势的产生机制及其对活动的影响。可获取视频摘要以获得作者更多见解（见视频，补充数字内容1，http://links.lww.com/JNPT/A164）。