Clinical assessment of upper limb impairments and functional capacity in Parkinson's disease: a systematic review

Abstract

Background Parkinson's disease (PD) may progressively reduce the upper limb's functionality. Currently, there is no standardized upper limb functional capacity assessment in PD in the rehabilitation field. Objective To identify specific outcome measurements to assess upper limbs in PD and access functional capacity. Methods We systematically reviewed and analyzed the literature in English published from August/2012 to August/2022 according to PRISMA. The following keywords were used in our search: “upper limbs” OR “upper extremity” and “Parkinson's disease.” Two researchers searched independently, including studies accordingly to our inclusion and exclusion criteria. Registered at PROSPERO CRD42021254486. Results We found 797 studies, and 50 were included in this review (n = 2.239 participants in H&Y stage 1–4). The most common upper limbs outcome measures found in the studies were: (i) UPDRS-III and MDS-UPDRS to assess the severity and progression of PD motor symptoms (tremor, bradykinesia, and rigidity) (ii) Nine Hole Peg Test and Purdue Pegboard Test to assess manual dexterity; (iii) Spiral test and Funnel test to provoke and assess freezing of upper limbs; (iv) Technology assessment such as wearables sensors, apps, and other device were also found. Conclusion We found evidence to support upper limb impairments assessments in PD. However, there is still a large shortage of specific tests to assess the functional capacity of the upper limbs. The upper limbs' functional capacity is insufficiently investigated during the clinical and rehabilitation examination due to a lack of specific outcome measures to assess functionality.

Reply to “Clinical assessment of upper limb impairments and functional capacity in Parkinson's disease”: defining upper limb functional capacity in people with Parkinson's disease

“…We appreciate the insightful remarks from our colleagues on our use of the term "functional capacity" in our manuscript in Arquivos de Neuro-Psiquiatria. 1,2 We concur that employing transparent terminology to discuss a frequently neglected aspect of Parkinson's disease (PD) managementthe assessment of upper limb functional capacityis important in the clinical discourse on movement disorders. Functional capacity generally refers to the ability to carry out necessary or desirable tasks under specific conditions.…”

“…Our PEDro search resulted in an additional 12 source articles shown in the flow diagram. 1 In-depth information about these sources is documented 1 such as an overview, characteristics, and specific outcomes of the studies, including the number of participants of each study (in total, n ¼ 2239).…”

Clinical assessment of upper limb impairments and functional capacity in Parkinson's disease

“…First and foremost, we express our gratitude towards the authors for their clear and concise description of the article titled “Clinical Assessment of upper limb impairments and functional capacity in Parkinson's Disease: a systematic review”. 1 While the study addresses an important gap in Parkinson disease (PD) research, particularly in the rehabilitation field, certain limitations and areas of improvement need to be addressed for the research to have a more substantial impact.…”

“…A clear and concise definition of this term would help readers better understand the scope and goals of the study. 1 There is a lack of clarity in the objective because, in the abstract, the main goal was to determine the precise outcome to measure upper limb function in PD and to access functional capacity. However, another goal was added later to the main article, which is currently undergoing revision, and the distinction between primary and secondary outcomes was not made.…”

Update on the diagnosis and treatment of neurological diseases

“…3 In the area of neuro-rehabilitation, Capato and colleagues present a robust article highlighting the news on assisted technology in Parkinson's disease gait. 4 The authors present new alternative interventions with assisted technology, which can be used to improve gait disorders in patients with Parkinson's disease. 4 In the area of epilepsy, Pinto and colleagues present the article entitled “Practices in the prescription of antiseizure medications: is it time to change?”.…”