Impact of motor fluctuations on real-life gait in Parkinson's patients

Ana Lígia Silva de Lima; Luc J.W. Evers; Tim Hahn; Nienke M. de Vries; Margaret Daeschler; Babak Boroojerdi; Dolors Terricabras; Max A. Little; Bastiaan R. Bloem; Marjan J. Faber

doi:10.1016/j.gaitpost.2018.03.045

Impact of motor fluctuations on real-life gait in Parkinson's patients

Ana Lígia Silva de Lima, Luc J.W. Evers, Tim Hahn, Nienke M. de Vries, Margaret Daeschler, Babak Boroojerdi, Dolors Terricabras, Max A. Little, Bastiaan R. Bloem, Marjan J. Faber

Research output: Contribution to journal › Article › peer-review

27 Citations (Scopus)

Abstract

Background: People with PD (PWP) have an increased risk of becoming inactive. Wearable sensors can provide insights into daily physical activity and walking patterns. Research questions: (1) Is the severity of motor fluctuations associated with sensor-derived average daily walking quantity? (2) Is the severity of motor fluctuations associated with the amount of change in sensor-derived walking quantity after levodopa intake? Methods: 304 Dutch PWP from the Parkinson@Home study were included. At baseline, all participants received a clinical examination. During the follow-up period (median: 97 days; 25-Interquartile range-IQR: 91 days, 75-IQR: 188 days), participants used the Fox Wearable Companion app and streamed smartwatch accelerometer data to a cloud platform. The first research question was assessed by linear regression on the sensor-derived mean time spent walking/day with the severity of fluctuations (MDS-UPDRS item 4.4) as independent variable, controlled for age and MDS-UPDRS part-III score. The second research question was assessed by linear regression on the sensor-derived mean post-levodopa walking quantity, with the sensor-derived mean pre-levodopa walking quantity and severity of fluctuations as independent variables, controlled for mean time spent walking per day, age and MDS-UPDRS part-III score. Results: PWP spent most time walking between 8am and 1pm, summing up to 72 ± 39 (mean ± standard deviation) minutes of walking/day. The severity of motor fluctuations did not influence the mean time spent walking (B = 2.4 ± 1.9, p = 0.20), but higher age (B = −1.3 ± 0.3, p = < 0.001) and greater severity of motor symptoms (B = −0.6 ± 0.2, p < 0.001) was associated with less time spent walking (F(3216) = 14.6, p <.001, R² =.17). The severity of fluctuations was not associated with the amount of change in time spent walking in relation to levodopa intake in any part of the day. Significance: Analysis of sensor-derived gait quantity suggests that the severity of motor fluctuations is not associated with changes in real-life walking patterns in mildly to moderate affected PWP.

Original language	English
Pages (from-to)	388-394
Number of pages	7
Journal	Gait and Posture
Volume	62
DOIs	https://doi.org/10.1016/j.gaitpost.2018.03.045
Publication status	Published - May 2018
Externally published	Yes

Bibliographical note

Funding Information:
Marjan J Faber received grant support from the Michael J Fox Foundation, the Stichting Parkinson Fonds, Philips Research, The Netherlands Organisation for Health Research and Development and Health Holland.

Funding Information:
Ana Lígia Silva de Lima is supported by CAPES foundation, Ministry of Education of Brazil [grant number 0428-140].

Funding Information:
Nienke M de Vries was supported by a research grant of The Netherlands Organisation for Health, Research and Development.

Funding Information:
The Parkinson@Home study was funded by the Michael J. Fox Foundation for Parkinson’s Research; by the Stichting Parkinson Fonds; by ZonMW [grant 91215076]; by UCB and by Philips Research. The Michael J. Fox Foundation for Parkinson’s Research had a role in study design and data collection. All other sponsors did not have any role in study design; in the collection, analysis and interpretation of the data; and in the decision to submit the paper for publication.

Funding Information:
Bastiaan R Bloem has previously served as an editorial board member of Movement Disorders, currently serves as Associate Editor for the Journal of Parkinson’s disease, received honoraria from serving on the scientific advisory board for Zambon, has received fees for speaking at conferences from AbbVie and Teva, and received research support from the Netherlands Organization for Scientific Research, the Michael J Fox Foundation, the Prinses Beatrix Foundation, the Stichting Parkinson Fonds, the National Parkinson Foundation and the Parkinson Vereniging.

Funding Information:
Margaret Daeschler are supported by the Michael J. Fox Foundation.

Publisher Copyright:
© 2018 Elsevier B.V.

ASJC Scopus Subject Areas

Biophysics
Orthopedics and Sports Medicine
Rehabilitation

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10.1016/j.gaitpost.2018.03.045

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@article{1f298a1f95ed46cd9793ecbe1e58ab5f,

title = "Impact of motor fluctuations on real-life gait in Parkinson's patients",

abstract = "Background: People with PD (PWP) have an increased risk of becoming inactive. Wearable sensors can provide insights into daily physical activity and walking patterns. Research questions: (1) Is the severity of motor fluctuations associated with sensor-derived average daily walking quantity? (2) Is the severity of motor fluctuations associated with the amount of change in sensor-derived walking quantity after levodopa intake? Methods: 304 Dutch PWP from the Parkinson@Home study were included. At baseline, all participants received a clinical examination. During the follow-up period (median: 97 days; 25-Interquartile range-IQR: 91 days, 75-IQR: 188 days), participants used the Fox Wearable Companion app and streamed smartwatch accelerometer data to a cloud platform. The first research question was assessed by linear regression on the sensor-derived mean time spent walking/day with the severity of fluctuations (MDS-UPDRS item 4.4) as independent variable, controlled for age and MDS-UPDRS part-III score. The second research question was assessed by linear regression on the sensor-derived mean post-levodopa walking quantity, with the sensor-derived mean pre-levodopa walking quantity and severity of fluctuations as independent variables, controlled for mean time spent walking per day, age and MDS-UPDRS part-III score. Results: PWP spent most time walking between 8am and 1pm, summing up to 72 ± 39 (mean ± standard deviation) minutes of walking/day. The severity of motor fluctuations did not influence the mean time spent walking (B = 2.4 ± 1.9, p = 0.20), but higher age (B = −1.3 ± 0.3, p = < 0.001) and greater severity of motor symptoms (B = −0.6 ± 0.2, p < 0.001) was associated with less time spent walking (F(3216) = 14.6, p <.001, R2 =.17). The severity of fluctuations was not associated with the amount of change in time spent walking in relation to levodopa intake in any part of the day. Significance: Analysis of sensor-derived gait quantity suggests that the severity of motor fluctuations is not associated with changes in real-life walking patterns in mildly to moderate affected PWP.",

author = "{Silva de Lima}, {Ana L{\'i}gia} and Evers, {Luc J.W.} and Tim Hahn and {de Vries}, {Nienke M.} and Margaret Daeschler and Babak Boroojerdi and Dolors Terricabras and Little, {Max A.} and Bloem, {Bastiaan R.} and Faber, {Marjan J.}",

note = "Funding Information: Marjan J Faber received grant support from the Michael J Fox Foundation, the Stichting Parkinson Fonds, Philips Research, The Netherlands Organisation for Health Research and Development and Health Holland. Funding Information: Ana L{\'i}gia Silva de Lima is supported by CAPES foundation, Ministry of Education of Brazil [grant number 0428-140]. Funding Information: Nienke M de Vries was supported by a research grant of The Netherlands Organisation for Health, Research and Development. Funding Information: The Parkinson@Home study was funded by the Michael J. Fox Foundation for Parkinson{\textquoteright}s Research; by the Stichting Parkinson Fonds; by ZonMW [grant 91215076]; by UCB and by Philips Research. The Michael J. Fox Foundation for Parkinson{\textquoteright}s Research had a role in study design and data collection. All other sponsors did not have any role in study design; in the collection, analysis and interpretation of the data; and in the decision to submit the paper for publication. Funding Information: Bastiaan R Bloem has previously served as an editorial board member of Movement Disorders, currently serves as Associate Editor for the Journal of Parkinson{\textquoteright}s disease, received honoraria from serving on the scientific advisory board for Zambon, has received fees for speaking at conferences from AbbVie and Teva, and received research support from the Netherlands Organization for Scientific Research, the Michael J Fox Foundation, the Prinses Beatrix Foundation, the Stichting Parkinson Fonds, the National Parkinson Foundation and the Parkinson Vereniging. Funding Information: Margaret Daeschler are supported by the Michael J. Fox Foundation. Publisher Copyright: {\textcopyright} 2018 Elsevier B.V.",

year = "2018",

month = may,

doi = "10.1016/j.gaitpost.2018.03.045",

language = "English",

volume = "62",

pages = "388--394",

journal = "Gait and Posture",

issn = "0966-6362",

publisher = "Elsevier",

}

TY - JOUR

T1 - Impact of motor fluctuations on real-life gait in Parkinson's patients

AU - Silva de Lima, Ana Lígia

AU - Evers, Luc J.W.

AU - Hahn, Tim

AU - de Vries, Nienke M.

AU - Daeschler, Margaret

AU - Boroojerdi, Babak

AU - Terricabras, Dolors

AU - Little, Max A.

AU - Bloem, Bastiaan R.

AU - Faber, Marjan J.

N1 - Funding Information: Marjan J Faber received grant support from the Michael J Fox Foundation, the Stichting Parkinson Fonds, Philips Research, The Netherlands Organisation for Health Research and Development and Health Holland. Funding Information: Ana Lígia Silva de Lima is supported by CAPES foundation, Ministry of Education of Brazil [grant number 0428-140]. Funding Information: Nienke M de Vries was supported by a research grant of The Netherlands Organisation for Health, Research and Development. Funding Information: The Parkinson@Home study was funded by the Michael J. Fox Foundation for Parkinson’s Research; by the Stichting Parkinson Fonds; by ZonMW [grant 91215076]; by UCB and by Philips Research. The Michael J. Fox Foundation for Parkinson’s Research had a role in study design and data collection. All other sponsors did not have any role in study design; in the collection, analysis and interpretation of the data; and in the decision to submit the paper for publication. Funding Information: Bastiaan R Bloem has previously served as an editorial board member of Movement Disorders, currently serves as Associate Editor for the Journal of Parkinson’s disease, received honoraria from serving on the scientific advisory board for Zambon, has received fees for speaking at conferences from AbbVie and Teva, and received research support from the Netherlands Organization for Scientific Research, the Michael J Fox Foundation, the Prinses Beatrix Foundation, the Stichting Parkinson Fonds, the National Parkinson Foundation and the Parkinson Vereniging. Funding Information: Margaret Daeschler are supported by the Michael J. Fox Foundation. Publisher Copyright: © 2018 Elsevier B.V.

PY - 2018/5

Y1 - 2018/5

N2 - Background: People with PD (PWP) have an increased risk of becoming inactive. Wearable sensors can provide insights into daily physical activity and walking patterns. Research questions: (1) Is the severity of motor fluctuations associated with sensor-derived average daily walking quantity? (2) Is the severity of motor fluctuations associated with the amount of change in sensor-derived walking quantity after levodopa intake? Methods: 304 Dutch PWP from the Parkinson@Home study were included. At baseline, all participants received a clinical examination. During the follow-up period (median: 97 days; 25-Interquartile range-IQR: 91 days, 75-IQR: 188 days), participants used the Fox Wearable Companion app and streamed smartwatch accelerometer data to a cloud platform. The first research question was assessed by linear regression on the sensor-derived mean time spent walking/day with the severity of fluctuations (MDS-UPDRS item 4.4) as independent variable, controlled for age and MDS-UPDRS part-III score. The second research question was assessed by linear regression on the sensor-derived mean post-levodopa walking quantity, with the sensor-derived mean pre-levodopa walking quantity and severity of fluctuations as independent variables, controlled for mean time spent walking per day, age and MDS-UPDRS part-III score. Results: PWP spent most time walking between 8am and 1pm, summing up to 72 ± 39 (mean ± standard deviation) minutes of walking/day. The severity of motor fluctuations did not influence the mean time spent walking (B = 2.4 ± 1.9, p = 0.20), but higher age (B = −1.3 ± 0.3, p = < 0.001) and greater severity of motor symptoms (B = −0.6 ± 0.2, p < 0.001) was associated with less time spent walking (F(3216) = 14.6, p <.001, R2 =.17). The severity of fluctuations was not associated with the amount of change in time spent walking in relation to levodopa intake in any part of the day. Significance: Analysis of sensor-derived gait quantity suggests that the severity of motor fluctuations is not associated with changes in real-life walking patterns in mildly to moderate affected PWP.

AB - Background: People with PD (PWP) have an increased risk of becoming inactive. Wearable sensors can provide insights into daily physical activity and walking patterns. Research questions: (1) Is the severity of motor fluctuations associated with sensor-derived average daily walking quantity? (2) Is the severity of motor fluctuations associated with the amount of change in sensor-derived walking quantity after levodopa intake? Methods: 304 Dutch PWP from the Parkinson@Home study were included. At baseline, all participants received a clinical examination. During the follow-up period (median: 97 days; 25-Interquartile range-IQR: 91 days, 75-IQR: 188 days), participants used the Fox Wearable Companion app and streamed smartwatch accelerometer data to a cloud platform. The first research question was assessed by linear regression on the sensor-derived mean time spent walking/day with the severity of fluctuations (MDS-UPDRS item 4.4) as independent variable, controlled for age and MDS-UPDRS part-III score. The second research question was assessed by linear regression on the sensor-derived mean post-levodopa walking quantity, with the sensor-derived mean pre-levodopa walking quantity and severity of fluctuations as independent variables, controlled for mean time spent walking per day, age and MDS-UPDRS part-III score. Results: PWP spent most time walking between 8am and 1pm, summing up to 72 ± 39 (mean ± standard deviation) minutes of walking/day. The severity of motor fluctuations did not influence the mean time spent walking (B = 2.4 ± 1.9, p = 0.20), but higher age (B = −1.3 ± 0.3, p = < 0.001) and greater severity of motor symptoms (B = −0.6 ± 0.2, p < 0.001) was associated with less time spent walking (F(3216) = 14.6, p <.001, R2 =.17). The severity of fluctuations was not associated with the amount of change in time spent walking in relation to levodopa intake in any part of the day. Significance: Analysis of sensor-derived gait quantity suggests that the severity of motor fluctuations is not associated with changes in real-life walking patterns in mildly to moderate affected PWP.

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Impact of motor fluctuations on real-life gait in Parkinson's patients

Abstract

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