Narita Masaru, Sakano Kosuke, Nakashiro Yuichi, Moriwaka Fumio, Hamada Shinsuke, Okada Yohei
Graduate School of Health Sciences, Kio University, Nara, Japan.
Department of Rehabilitation, Hokkaido Neurological Hospital, Sapporo, Japan.
J Mov Disord. 2025 Jul;18(3):231-243. doi: 10.14802/jmd.25035. Epub 2025 Apr 25.
OBJECTIVE: People with Parkinson's disease (PwPD) experience a gradual decline in bed mobility independence as the disease progresses. Identifying factors associated with nonindependence in daytime bed mobility is crucial for developing effective interventions to increase independence. We investigated factors associated with nonindependence in daytime bed mobility in PwPD. METHODS: This cross-sectional study included 109 PwPD (Hoehn and Yahr [HY] stage 2-4). Patients' bed mobility ability (turning in bed, supine-to-sitting, and sitting-to-supine) was assessed during the daytime, and they were categorized into independent and nonindependent groups. Potential factors associated with bed mobility independence, including components of the Movement Disorders Society-Unified Parkinson's Disease Rating Scale (rigidity, bradykinesia, tremor, axial symptoms), neck/trunk/hip strength, the Mini-Mental State Examination, and the Trail Making Test-A and B, were evaluated. RESULTS: The nonindependent group presented significantly increased axial symptoms, increased rigidity in the upper and lower limbs and neck, increased upper limb bradykinesia, and decreased trunk flexion/extension strength in all bed mobility tasks (p<0.05). Multivariate regression analyses revealed that axial symptoms, upper limb rigidity, and trunk extension strength were highly discriminative for nonindependence in turning in bed (the area under the curve [AUC]=0.84). Similarly, upper limb rigidity and axial symptoms were predictive of nonindependence in supine-to-sitting and sitting-to-supine movements (AUC=0.78, 0.92). A significant difference in axial symptoms between the HY stage 4 subgroups was observed only in the sitting-to-supine movement. CONCLUSION: Our findings indicate that axial symptoms and upper limb rigidity are key factors contributing to nonindependence in daytime bed mobility tasks among PwPD. Targeting these factors in rehabilitation may help mitigate the decline in bed mobility independence in PwPD.
目的:帕金森病患者(PwPD)随着疾病进展,其床上活动独立性会逐渐下降。识别与日间床上活动不独立相关的因素对于制定有效的干预措施以提高独立性至关重要。我们调查了PwPD患者日间床上活动不独立的相关因素。 方法:这项横断面研究纳入了109例PwPD患者(Hoehn和Yahr [HY]分期为2 - 4期)。在白天评估患者的床上活动能力(在床上翻身、仰卧到坐起以及坐起到仰卧),并将他们分为独立组和非独立组。评估了与床上活动独立性相关的潜在因素,包括运动障碍协会统一帕金森病评定量表的各项内容(强直、运动迟缓、震颤、轴性症状)、颈部/躯干/髋部力量、简易精神状态检查以及连线测验A和B。 结果:非独立组在所有床上活动任务中均表现出轴性症状显著增加、上肢和下肢及颈部强直增加、上肢运动迟缓增加以及躯干屈伸力量下降(p<0.05)。多因素回归分析显示,轴性症状、上肢强直和躯干伸展力量对在床上翻身的不独立性具有高度判别性(曲线下面积[AUC]=0.84)。同样,上肢强直和轴性症状可预测仰卧到坐起以及坐起到仰卧动作的不独立性(AUC=0.78,0.92)。仅在坐起到仰卧动作中观察到HY 4期亚组之间轴性症状存在显著差异。 结论:我们的研究结果表明,轴性症状和上肢强直是导致PwPD患者日间床上活动任务不独立的关键因素。在康复治疗中针对这些因素可能有助于减轻PwPD患者床上活动独立性的下降。
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