Perception and Use of Compensation Strategies for Gait Impairment by Persons With Parkinson Disease

摘要

Background and Objectives: Gait impairments are common and disabling in Parkinson disease (PD). Applying compensation strategies helps to overcome these gait deficits. Clinical observations suggest that the efficacy of different compensation strategies varies depending on both individual patient characteristics and the context in which the strategies are applied. This has never been investigated systematically, hampering the ability of clinicians to provide a more personalized approach to gait rehabilitation. We had 3 aims: (1) to evaluate patients' awareness and actual use of compensation categories for gait impairments in PD, (2) to investigate the patient-rated efficacy of the various compensation strategies and whether this efficacy depends on the context in which the strategies are applied, and (3) to explore differences in the efficacy between subgroups based on sex, age, disease duration, freezing status, and ability to perform a dual task. Methods: A survey was conducted among 4,324 adults with PD and self-reported disabling gait impairments. Results: The main findings are as follows: (1) compensation strategies for gait impairments are commonly used by persons with PD, but their awareness of the full spectrum of available strategies is limited; (2) the patient-rated efficacy of compensation strategies is high but varies depending on the context in which they are applied; and (3) compensation strategies are useful for all types of patients with PD, but the efficacy of the different strategies varies per person. Discussion: The choice of compensation strategies for gait impairment in PD should be tailored to the individual patient and to the context in which the strategy needs to be applied. Classification of Evidence: This data provides Class IV evidence that compensation strategies are an effective treatment for gait impairment in patients with PD.