ASSESSMENT OF UPPER LIMBS FUNCTIONAL CAPACITY IN PARKINSON'S DISEASE: A SYSTEMATIC REVIEW

R. Rodrigues¹, R. Cury¹, E. Barbosa¹, T. Capato^1,2

¹University of São Paulo, Neurology Department, São Paulo, Brazil, ²Radboudumc, Neurology Department, Nijmegen, Netherlands

Background: Parkinson's disease (PD) leads to a progressive reduction of upper limbs functional capacity by bradykinesia, tremor, and rigidity. Only a few tests for assessment of upper limbs impairments in PD are available, and a standard upper limbs functional capacity assessment in PD is unknown.

Purpose: To identify the outcome measurements to assess upper limbs functional capacity in PD.

Methods: We systematically reviewed the literature published from August 2012 to August 2022 according to PRISMA. We analyzed published studies from a systematic review in PubMed, using the following keywords: "upper limbs"([All Fields]) OR “upper extremity” "[All Fields] and "Parkinson’s disease"[All Fields])). This study was registered at PROSPERO CRD42021254486. Two researchers carried out the search independently, and a consensus meeting was held when needed. Studies that don't mention Parkinson’s disease and that don't present upper limbs interventions were excluded.

Results: We found initially a total of 797 studies, 785 in PubMed and 12 in other sources. According to the inclusion and exclusion criteria, 55 studies published in English were included in this review. No studies were found to assess specifically upper limbs functional capacity in PD. The most common upper limbs outcome measures found in the studies were: (i) to assess severity and progression of PD motor symptoms (tremor e bradykinesia): UPDRS-III (n=29), MDS-UPDRS (n=18), Nine Hole Peg Test (n=8), Purdue Pegboard Test (n=5), Fahn-Tolosa-Marin Tremor Rating Scale (n=7); (ii) to assess manual dexterity: Nine Hole Peg Test (n=8) and Purdue Pegboard Test (n=5); (iii) to provoke and assess freezing of upper limbs (FOUL) Spiral test (n=4) Funnel test (n=2); (iv) Technology assessment and wearable sensors (n=5), app or digital platform (n=5). In total, were included 2.387 participants, with mean age of 61.16; in H&Y stage 2 (2;3). So far, the upper limbs' functional capacity is under-investigated during the functional clinical examination due to a lack of specific outcome measures. The upper limbs impairments can be very disabling during daily life activities. Only a few studies have shown that it is possible to assess upper limbs impairments such as tremor, bradykinesia and manual dexterity of upper limbs. We should verify objectively FOUL, and if is present, e.g., by evaluating the spiral-drawing task or the funnel task. The current physiotherapy guidelines for PD provide no strong recommendations for assessing upper limbs. Using technology to assess outcome measurements to assess upper limbs impairments area promising strategy.

Conclusions: Current evidence is insufficient to recommend standard and outcome measures to assess upper limb functional capacity impairments in PD. Therefore, there is a clear need for a practical and standardized upper limb assessment. This review highlights the need to develop an instrument to assess functional capacity in clinical practice. Further studies should investigate technological advances both to refine and to support the outcome of assessing upper limb impairments.

Implications: This study contributes to evidence to support physiotherapist assessments and clinical decisions. Upper limbs deserve tailored assessment and patients must be investigated about FOUL and functional capacity impairments by a physiotherapist with expertise in PD management.

Funding acknowledgements: We also thank the support of University of São Paulo and PHYSICAL Parkinson’s Disease and Movement Disorders Rehabilitation Center

Keywords:
Parkinson's disease
Upper limbs
Functional capacity

Topics:
Neurology: Parkinson's disease
Neurology
Disability & rehabilitation

Did this work require ethics approval? No

Reason: This is a systematic review. This study was registered at PROSPERO CRD42021254486.