Impact of forward and backward walking on gait parameters across parkinson’s disease stages and severity: a prospective observational study
Résumé
Background Parkinson's disease (PD) is characterized by motor symptoms altering gait domains such as slow walking speed, reduced step and stride length, and increased double support time. Gait disturbances occur in the early, mild to moderate, and advanced stages of the disease in both backward walking (BW) and forward walking (FW), but are more pronounced in BW. At this point, however, no information is available about BW performance and disease stages specified using the Hoehn and Yahr (H&Y) scale. The objectives of this study were to examine the link between clinical scores and gait parameters in PD, and to assess gait parameters in both FW and BW among PD patients in early disease stages (H&Y: 1-2) and advanced disease stages (H&Y: 3-4), as well as among PD patients with mild and moderate disease severity as per the Movement Disorder Society-Unified Parkinson's Disease Rating Scale Part III (MDS-UPDRS III). Methods Spatiotemporal gait parameters were analyzed during FW and BW over a 5-meter walkway at a comfortable speed using 3D motion capture. Correlations and regressions between clinical scores and gait parameters were examined. Wilcoxon Mann-Whitney rank sum tests were used to compare PD patients in early and advanced disease stages and assess differences in gait parameters for both FW and BW conditions. Results The study included a total of 25 PD patients (aged 65 ± 9 years), among whom 10 were in the H&Y stages 1-2 and 15 in stages 3-4. All participants were evaluated with the MDS-UPDRS III, with 17 having a total score ≤ 32 (mild impairment and disability) and 8 having a total score > 32 (moderate impairment and disability). During BW, PD patients with H&Y stages 1-2 had significantly (p < 0.05) longer step lengths, stride lengths, and a higher walk ratio compared to those with H&Y stage 3-4. Regardless of the walking condition, no difference was found between PD patients with a MDS-UPDRS III total score ≤ 32 and patients with a MDS-UPDRS III total score > 32. Discussion The study demonstrates that individuals with PD in H&Y stages 3-4 exhibit compromised FW and BW abilities in comparison to those in stages 1-2. Notably, the disparities are more prominent in the realm of backward
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