HAND FUNCTION IMPAIRMENT IN PARKINSON’S DISEASE: WHAT IS THE BEST WAY TO DETECT IT?

C. Cabral Gonzalez Alonso Rocha¹, P. Barbosa de Freitas², D. Dalton Lustosa de Oliveira¹, R. Pires¹, S. Freitas¹

Background: Parkinson’s disease (PD) cardinal manifestations (tremor, bradykinesia, and rigidity), poor digits and hand dexterity, and reduced strength have been responsible for the hand function impairments. Several timed dexterity tests have been described to be able to detect small changes in hand function. However, these findings were based on the application of one of the hand function tests.  

Purpose: We aimed to find the best hand function tests to detect hand impairment in individuals with PD and to examine whether any of those tests could be useful to differentiate individuals with PD in different stages and disease progression.

Methods: Twenty-four individuals with PD (Hoehn and Yahr – H&Y: I-III) and 56 healthy controls performed the Jebsen-Taylor Hand Function Test (JTHFT), Nine-Hole Peg Test (9HPT), and maximum power grip and pinch strength tests. Eight PD participants were reassessed after 18 months. The ability of the tests to discriminate individuals with PD from healthy controls was evaluated by the receiver operating characteristic (ROC) curve analyses. We calculated the area under the ROC curve (AUC), with values close to 1 suggesting high diagnostic accuracy of the test. The best cutoff point (determined by the best combination of specificity and sensitivity using the Youden Index method), sensitivity, and specificity were calculated for those variables with significant AUC. We also performed ROC curve analyses for combinations of variables with AUC>0.8.

Results: PD patients showed worst performance than controls in all tests, except the writing subtest of the JTHFT and maximum power strength. Two subtests of the JTHFT (turning cards and moving large, heavy objects) were the best tests discriminating PD patients from controls. Performance in the 9HPT and simulated feeding subtest of the JTHFT were sensitive to distinguish individuals with PD H&YI =1 from H&Y>1. In contrast, only the performance in the 9HPT was sensitive to PD progression.

Conclusion(s): In sum, two dexterity subtests of the JTHFT were highly discriminative of the hand function impairments in PD. The 9HPT provides the most accurate identification of the PD stage and progression.

Implications: The test that best discriminates individuals with PD from healthy controls could be routinely used for assessment in clinical settings and be selected as a primary or secondary outcome variable of clinical trials involving individuals with PD.

Funding, acknowledgements: This study received support in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brazil (CAPES) to Alonso.

Keywords: assessment, dexterity, Parkinson disease

Topic: Disability & rehabilitation

Did this work require ethics approval? Yes

Institution: Universidade Cidade de São Paulo

Committee: SECID - SOCIEDADE EDUCACIONAL CIDADE DE SAO PAULO LTDA

Ethics number: 02891118.0.0000.8084