Desempenho físico-funcional, cognitivo emocional e fatores de risco relacionados à ocorrência de quedas em indivíduos com doença de Parkinson residentes em Natal-RN: um estudo transversal

Abstract

Article 1 – Analyze the epidemiological description of individuals with Parkinson’s disease (PD), according to clustered measures, in line with the conceptual structure of the International Classification of Functionality, Disability and Health (ICF); Article 2 – Assess the prevalence of falls and associated factors in recurrent fallers and non-fallers with PD. Method: Analytical cross-sectional study with a sample of 78 individuals with PD, residing in Natal, Rio Grande do Norte state, Brazil. Sociodemographic information and that related to physical functioning, mental health and quality of life was collected using 14 instruments categorized in the domains “Structure and Body function”, “Activity” and “Participation”. For the “Structure and Body function” domain the following instruments were used: Hoehn & Yahr (HY) Disability Scale, Montreal Cognitive Assessment (MoCA), Unified Parkinson Disease Rating Scale - UPDRS (part III, motor subscale), Grip strength, Geriatric Depression Scale (GDS - 15) and Falls Efficacy Scale – International (FES - I). The following were applied for the “Activity” domain: Nine Hole Peg Test (9HPT), UPDRS (part II, activities of daily life), Freezing of Gait Questionnaire (FOGQ), MiniBESTest, Timed Up & Go (TUG), Human Activity Profile (HAP), 10 Meter Walking Test (10MWT) and Five Times Sit to Stand (STDP - 5X). In the “Participation” domain, the Parkinson Disease Quality of Life Questionnaire (PDQ – 39) test was used. All participants were assessed during the “ON” time of antiparkinsonian medication. Statistical analysis was conducted using Statistical Package for Social Sciences (SPSS Inc., Chicago, USA) 21.0 software. Data normality was verified by the Shapiro-Wilks test, adopting p < 0.05. Article 1 – The variables related to physical functioning, mental health and quality of life were compared between sexes using the Student’s t-test for independent samples and the Mann-Whitney U test. Article 2 – Binary logistic regression was applied to determine the predictors of falls, where variables with p < 0.10 were included in the final multivariate model. Results: Article 1 – More than half the sample (64.1%) was composed of men, with higher prevalence in the 70-79 year age group (35.9%). With respect to the number of comorbidities, 52 (66.7%) had 4 or more and the most reported were visual dysfunction (87.2%). Significant differences were observed between men and women for grip strength (p= 0.001), MiniBESTest (p=0.034), FES – I (p=0.004) and PDQ – 39 (p=0.006), where women exhibited worse performance. Dementia (64.1%) was present in the entire sample. Article 2 – In regard to history of falls, 47 (60.3%) individuals in the sample were classified as “non-fallers” and 31 (39.7%) as “recurring fallers”. The following risk factors were associated with recurring falls: prolonged PD [OR=1.24, (95% CI=1.05–1.47), p=0.010], presence of systemic hypertension [OR=5.81, (95% CI=1.46–23.09), p=0.012), evacuation difficulties [OR=3.71, (95% CI=1.01–13.66), p=0.048] and presence of freezing [OR=3.78, (95% CI=1.02–13.97), p=0.046]. Conclusion: The sample was predominantly male, elderly, physically disabled or inactive, with the presence of dementia, depressive symptoms and a majority classified as “non-fallers”. PD duration, systemic hypertension, evacuation difficulties, and freezing are risk factors for recurring falls in the study sample. Knowledge of the sociodemographic and clinical characteristics in the population with PD would provide physiotherapists and the health team with better understanding of its prognosis, thereby contributing to planning therapies that meet the real demands of this population.