People with Parkinson's disease often have walking difficulty, and this is likely to be exacerbated while walking in places in the community, where people are likely to face greater and more varied challenges. This study aims to understand the facilitators and the barriers to walking in the community perceived by people with Parkinson's disease. This qualitative study involved 5 focus groups ( ) of people with Parkinson's disease and their partners residing in metropolitan and rural regions in Queensland, Australia. Results found that people with PD reported to use internal personal strategies as facilitators to community walking, but identified primarily external factors, particularly the environmental factors as barriers. The adoption of strategies or the use of facilitators allows people with Parkinson's disease to cope so that participants often did not report disability. 1. Introduction Community ambulation is compromised in many people living with Parkinson’s disease (PD), which is thought to affect around 2 percent of the population over the age of 65 [1]. Gait changes are a hallmark of PD, and people with PD frequently walk with reduced speed and step length [2, 3], reduced cadence [2–5], and increased gait variability [6]. People with PD may also experience freezing when walking. Walking difficulties are exacerbated when attention is drawn away from walking by performing additional tasks [5–9]. Challenging environments that demand attention may also compromise the ability to walk in people with this debilitating condition. Community walking is an important enabler to participation in community activities and a range of societal, work, and leisure roles. It has been defined as locomotion in environments outside the home or the residence [10]. This includes the ability to negotiate public and private venues both indoors and outdoors that incorporate a variety of environmental demands [10, 11], which could prove challenging for people with PD. The physical, social, and attitudinal environments are generally more varied and less predictable in the community than for the home or the laboratory settings. Walking in the community is generally assumed to be a more complex and high-level skill than walking around the home or in the laboratory. Research in older adults suggests that loss of walking function is a gradual process which results in a restriction of the variety of places they go to and the distance they will venture from home [12]. Impairments can accelerate this, and disabled older adults report fewer encounters with and greater avoidance of
References
[1]
G. Alves, E. B. Forsaa, K. F. Pedersen, M. Dreetz Gjerstad, and J. P. Larsen, “Epidemiology of Parkinson's disease,” Journal of Neurology, vol. 255, supplement 5, pp. 18–32, 2008.
[2]
O. Blin, A. M. Ferrandez, and G. Serratrice, “Quantitative analysis of gait in Parkinson patients: increased variability of stride length,” Journal of the Neurological Sciences, vol. 98, no. 1, pp. 91–97, 1990.
[3]
M. E. Morris, R. Iansek, T. A. Matyas, and J. J. Summers, “The pathogenesis of gait hypokinesia in Parkinson's disease,” Brain, vol. 117, no. 5, pp. 1169–1181, 1994.
[4]
M. Morris, R. Iansek, T. Matyas, and J. Summers, “Abnormalities in the stride length-cadence relation in parkinsonian gait,” Movement Disorders, vol. 13, no. 1, pp. 61–69, 1998.
[5]
K. Baker, L. Rochester, and A. Nieuwboer, “The immediate effect of attentional, auditory, and a combined cue strategy on gait during single and dual tasks in Parkinson's disease,” Archives of Physical Medicine and Rehabilitation, vol. 88, no. 12, pp. 1593–1600, 2007.
[6]
G. Yogev, N. Giladi, C. Peretz, S. Springer, E. S. Simon, and J. M. Hausdorff, “Dual tasking, gait rhythmicity, and Parkinson's disease: which aspects of gait are attention demanding?” European Journal of Neuroscience, vol. 22, no. 5, pp. 1248–1256, 2005.
[7]
R. Galletly and S. G. Brauer, “Does the type of concurrent task affect preferred and cued gait in people with Parkinson's disease?” Australian Journal of Physiotherapy, vol. 51, no. 3, pp. 175–180, 2005.
[8]
J. M. Hausdorff, J. Balash, and N. Giladi, “Effects of cognitive challenge on gait variability in patients with Parkinson's disease,” Journal of Geriatric Psychiatry and Neurology, vol. 16, no. 1, pp. 53–58, 2003.
[9]
S. O'Shea, M. E. Morris, and R. Iansek, “Dual task interference during gait in people with Parkinson disease: effects of motor versus cognitive secondary tasks,” Physical Therapy, vol. 82, no. 9, pp. 888–897, 2002.
[10]
A. E. Patla and A. Shumway-Cook, “Dimensions of mobility: defining the complexity and difficulty associated with community mobility,” Journal of Aging and Physical Activity, vol. 7, no. 1, pp. 7–19, 1999.
[11]
S. E. Lord, K. McPherson, H. K. McNaughton, L. Rochester, and M. Weatherall, “Community ambulation after stroke: how important and obtainable is it and what measures appear predictive?” Archives of Physical Medicine and Rehabilitation, vol. 85, no. 2, pp. 234–239, 2004.
[12]
C. Peel, P. S. Baker, D. L. Roth, C. J. Brown, E. V. Bodner, and R. M. Allman, “Assessing mobility in older adults: the UAB Study of Aging Life-Space Assessment,” Physical Therapy, vol. 85, no. 10, pp. 1008–1019, 2005.
[13]
A. Shumway-Cook, A. Patla, A. Stewart, L. Ferrucci, M. A. Ciol, and J. M. Guralnik, “Environmental components of mobility disability in community-living older persons,” Journal of the American Geriatrics Society, vol. 51, no. 3, pp. 393–398, 2003.
[14]
J. Green and N. Thorogood, Qualitative Methods for Health Research, London, UK, 2nd edition, 2009.
[15]
L. M. Shulman, A. L. Gruber-Baldini, K. E. Anderson et al., “The evolution of disability in Parkinson disease,” Movement Disorders, vol. 23, no. 6, pp. 790–796, 2008.
[16]
M. A. Plow, L. Resnik, and S. M. Allen, “Exploring physical activity behaviour of persons with multiple sclerosis: a qualitative pilot study,” Disability and Rehabilitation, vol. 31, no. 20, pp. 1652–1665, 2009.
[17]
B. R. Bloem, J. M. Hausdorff, J. E. Visser, and N. Giladi, “Falls and freezing of gait in Parkinson's disease: a review of two interconnected, episodic phenomena,” Movement Disorders, vol. 19, no. 8, pp. 871–884, 2004.
[18]
R. G. Brown, A. Dittner, L. Findley, and S. C. Wessely, “The Parkinson fatigue scale,” Parkinsonism and Related Disorders, vol. 11, no. 1, pp. 49–55, 2005.
[19]
I. Ziv, M. Avraham, Y. Michaelov et al., “Enhanced fatigue during motor performance in patients with Parkinson's disease,” Neurology, vol. 51, no. 6, pp. 1583–1586, 1998.
[20]
L. P. Fried, K. Bandeen-Roche, P. H. M. Chaves, and B. A. Johnson, “Preclinical mobility disability predicts incident mobility disability in older women,” Journals of Gerontology, vol. 55, no. 1, pp. M43–M52, 2000.
[21]
L. P. Fried, Y. Young, G. Rubin, and K. Bandeen-Roche, “Self-reported preclinical disability identifies older women with early declines in performance and early disease,” Journal of Clinical Epidemiology, vol. 54, no. 9, pp. 889–901, 2001.
[22]
D. Jones, L. Rochester, A. Birleson et al., “Everyday walking with Parkinson's disease: understanding personal challenges and strategies,” Disability and Rehabilitation, vol. 30, no. 16, pp. 1213–1221, 2008.
[23]
M. Asano, W. C. Miller, and J. J. Eng, “Development and psychometric properties of the ambulatory self-confidence questionnaire,” Gerontology, vol. 53, no. 6, pp. 373–381, 2007.
[24]
A. Shumway-Cook, A. Patla, A. L. Stewart, L. Ferrucci, M. A. Ciol, and J. M. Guralnik, “Assessing environmentally determined mobility disability: self-report versus observed community mobility,” Journal of the American Geriatrics Society, vol. 53, no. 4, pp. 700–704, 2005.
[25]
J. A. Howe, E. L. Inness, A. Venturini, J. I. Williams, and M. C. Verrier, “The Community Balance and Mobility Scale—a balance measure for individuals with traumatic brain injury,” Clinical Rehabilitation, vol. 20, no. 10, pp. 885–895, 2006.
[26]
L. A. Hale, J. Pal, and I. Becker, “Measuring free-living physical activity in adults with and without neurologic dysfunction with a triaxial accelerometer,” Archives of Physical Medicine and Rehabilitation, vol. 89, no. 9, pp. 1765–1771, 2008.
[27]
S. F. Chastin, K. Baker, D. Jones, D. Burn, M. H. Granat, and L. Rochester, “The pattern of habitual sedentary behavior is different in advanced Parkinson's disease,” Movement Disorders, vol. 25, no. 13, pp. 2114–2120, 2010.
[28]
B. Dijkstra, Y. P. Kamsma, and W. Zijlstra, “Detection of gait and postures using a miniaturized triaxial accelerometer-based system: accuracy in patients with mild to moderate Parkinson's disease,” Archives of Physical Medicine and Rehabilitation, vol. 91, no. 8, pp. 1272–1277, 2010.
