Title : Value of a multidimensional assessment of balance and gait disorders in patients with intermediate-stage Parkinson's disease
Abstract:
Introduction: Balance and gait disorders (BGD) are disabling manifestations of Parkinson's disease (PD) from the intermediate stages onwards. Their multifactorial pathophysiology limits the value of any single test and justifies a multidimensional approach. This study aimed to evaluate the relevance of a battery of clinical and functional tools to characterize BGD and their functional consequences in patients with PD at Hoehn and Yahr stages II and III.
Methods: This was a prospective descriptive study including 53 patients with PD. The assessment tools explored complementary dimensions of BGD. BGD were assessed using the MDS-UPDRS II and III, the Mini-BESTest, the Tinetti test, the Timed Up and Go (TUG), the 10-meter and 6-minute walk tests (10MWT, 6MWT), the single-leg stance test, a dual-task test (Stops Walking When Talking), and the PDQ-39. Relationships between parameters were analyzed using correlation tests.
Results: The assessment revealed a global impairment of gait and balance, with a mean walking speed of 0.85 ± 0.13 m/s, a Mini-BESTest score of 17.2 ± 3.6, and a Tinetti score of 22.6 ± 4.7. In addition, 62.3% of patients stopped walking during the dual task, and 39.6% reported at least one recent fall.
Motor severity (MDS-UPDRS III) was significantly associated with the main locomotor parameters, notably the TUG (ρ = 0.481; p < 0.001), walking speed (ρ = −0.402; p = 0.003), and the Mini-BESTest (ρ = −0.373; p = 0.006).
Walking speed was the most discriminating parameter, with strong correlations with functional mobility (TUG, ρ = −0.814), endurance (6MWT, ρ = 0.600), fall risk (Tinetti, ρ = 0.553; falls, ρ = −0.509), and quality of life (PDQ-39, ρ = −0.510; all p < 0.001). Finally, the Tinetti test showed the strongest correlation with the occurrence of falls (ρ = −0.692; p < 0.001), while the Mini-BESTest was significantly correlated with all the locomotor dimensions studied.
Conclusion: BGD in the intermediate stages of PD combine complementary motor, postural, and locomotor deficits that no single test can capture. A multidimensional assessment, combining clinical scales and functional tests, allows a more precise characterization of impairments, a better estimation of fall risk, and more relevant targeting of management in physical and rehabilitation medicine.
Keywords: Parkinson's disease; gait; balance; multidimensional assessment; fall risk; physical and rehabilitation medicine.
