Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
Serviço de Anestesiologia, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.
J Parkinsons Dis. 2020;10(4):1301-1314. doi: 10.3233/JPD-202035.
Parkinson's disease (PD) is a neurological condition characterized by the development of daily disabling symptoms. Although the architecture and design of a PD patient's environment can hinder or facilitate full participation in daily activities, their putative role in the management of these patients has received little attention to date.
We conducted a systematic review to evaluate the evidence of architectural and design features in the management of people with PD.
An electronic database search of observational and experimental studies was conducted in MEDLINE and Embase from inception to May 2020, with two independent reviewers identifying the studies. Falls, fear of falling, postural instability, gait impairment/disability, and functional mobility were our outcomes of interest.
Thirty-six studies were included, among which nineteen were observational and seventeen were experimental studies (overall participants = 2,965). Pavement characteristics, notably unstable surfaces and level differences, were found to be a major cause of falling. Ground-based obstacles and confined/narrowed spaces were found to disturb gait, increase postural instability, and decrease functional mobility. Housing type did not appear to increase risk of falling, nor to significantly explain concerns about falling.
Findings suggest a need to adjust architectural features of the surrounding space to ensure appropriate care and provide a safe environment to PD patients. More evidence about the impact of such modifications on PD outcomes is needed.
帕金森病（PD）是一种神经系统疾病，其特征是出现日常活动障碍症状。尽管 PD 患者的环境结构和设计可以阻碍或促进他们充分参与日常活动，但迄今为止，人们对其在这些患者管理中的作用关注甚少。
我们进行了一项系统评价，以评估建筑和设计特征在 PD 患者管理中的作用。
我们对 MEDLINE 和 Embase 中的观察性和实验性研究进行了电子数据库检索，从建库开始至 2020 年 5 月，由两名独立的审查员确定研究。我们关注的结局包括跌倒、跌倒恐惧、姿势不稳、步态障碍/残疾和功能性移动能力。
共纳入 36 项研究，其中 19 项为观察性研究，17 项为实验性研究（总参与者为 2965 人）。发现路面特征，特别是不稳定的表面和水平差异，是导致跌倒的主要原因。地面障碍物和狭窄/受限空间会干扰步态，增加姿势不稳，并降低功能性移动能力。住房类型似乎不会增加跌倒的风险，也不会显著解释对跌倒的担忧。
研究结果表明，需要调整周围空间的建筑特征，以确保为 PD 患者提供适当的护理和安全的环境。需要更多关于这些改造对 PD 结局影响的证据。
