Slaug B, Iwarsson S, Ayala J A, Nilsson M H
Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
Acta Neurol Scand. 2017 Nov;136(5):501-510. doi: 10.1111/ane.12763. Epub 2017 Apr 9.
Promoting accessible housing for all citizens is high on the political agenda. Knowledge is, however, limited regarding housing accessibility problems for people with Parkinson's disease (PD). The objectives were to investigate housing accessibility problems among people with PD at different stages of disease severity and to analyze the potential impact of improved functional ability on accessibility problems.
The study included 253 participants with PD (61% men; mean age 70 years). Disease severity was assessed by the Hoehn and Yahr (HY) I-V stages: HY I, n=50; II, n=73, III, n=66; IV-V, n=64. Using the Housing Enabler (HE) instrument, accessibility problems were investigated by combining assessments of the person's functional capacity with assessments of physical barriers in the housing environment into a person-environment fit measure (HE-score). To analyze potential impact of improved functional ability on housing accessibility problems, data simulation was applied.
HE-scores differed significantly (P<.001) in relation to HY stages. Overall balance problems explained 22% and walking devices 17% of the HE-scores, whereas environmental barriers contributed to a lesser extent. The environmental barriers generating the most HE-scores were "no grab bar at shower/bath/toilet" and "wall-mounted cupboards and shelves placed high". A simulation of improved balance significantly (P<.001) lowered the HE-scores in all HY stages.
The results suggest that actions targeting balance problems and dependence on walking devices have the greatest potential for reducing housing accessibility problems for people with PD. The study also details environmental barriers that need specific attention when providing housing adaptation services.
推动为所有公民提供无障碍住房在政治议程中占据重要位置。然而，关于帕金森病（PD）患者的住房无障碍问题，我们所知有限。本研究的目的是调查不同疾病严重程度阶段的PD患者的住房无障碍问题，并分析功能能力改善对无障碍问题的潜在影响。
该研究纳入了253名PD患者（61%为男性；平均年龄70岁）。疾病严重程度通过Hoehn和Yahr（HY）I - V期进行评估：HY I期，n = 50；II期，n = 73；III期，n = 66；IV - V期，n = 64。使用住房促进者（HE）工具，通过将对个人功能能力的评估与对住房环境中物理障碍的评估相结合，形成个人 - 环境适配度测量（HE评分），来调查无障碍问题。为了分析功能能力改善对住房无障碍问题的潜在影响，应用了数据模拟。
HE评分在不同HY阶段存在显著差异（P <.001）。总体平衡问题对HE评分的解释率为22%，行走辅助设备为17%，而环境障碍的影响较小。导致HE评分最高的环境障碍是“淋浴/浴缸/厕所处没有扶手”和“墙上安装的橱柜和架子位置较高”。平衡能力改善的模拟显著（P <.001）降低了所有HY阶段的HE评分。
结果表明，针对平衡问题和对行走辅助设备的依赖采取行动，对于减少PD患者的住房无障碍问题具有最大潜力。该研究还详细说明了在提供住房适应性服务时需要特别关注的环境障碍。
