Walking Deficits in People with Parkinson’s Disease and Osteoarthritis

Justin Daniels

Authors:  Justin Daniels, Abigail Schmitt, Chris Hass

Faculty Mentor:  Chris Hass

College:  College of Health and Human Performance

Abstract

Parkinson’s disease (PD) is a neurodegenerative disorder that causes motor complications including tremor, bradykinesia, and gait dysfunction. Comorbidities of PD can exacerbate motor symptoms. Recent evidence suggests that osteoarthritis (OA) may be the most prevalent comorbidity associated with PD. OA is an inflammatory condition characterized by joint deterioration that also results in walking deficits. Yet the combined impact of OA and PD on walking is unknown. Twelve participants (average age 72±4 years, 10 males) walked comfortably across an 8m walkway while data were collected using three-dimensional motion capture and analyzed for spatiotemporal parameters of gait. Each participant received bilateral knee x-rays to determine presence and severity/grade of osteoarthritis. Participants with PD and evidence of OA exhibited decreased gait speed (1.06m/s vs. 1.19m/s), decreased cadence (109.8 steps/min vs. 119.8 steps/min), and increased time spent in double support (23.9% vs. 20.1%) when compared to those with PD alone. Conversely, participants with PD and OA had similar step lengths (0.56m vs 0.58m) as those with PD alone. These findings suggest the need for thorough screening for OA in patients with PD, as the overlapping symptoms from these coexisting conditions may lead to less effective treatment outcomes if the OA is left untreated.

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Poster

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Heather Gibson
Heather Gibson (@guest_1600)
1 year ago

Thanks Justin. An interesting study!

So just to summarize what you found – OA particularly in lower limbs leads to decreased mobility and balance which is then compounded by the effects of Parkinson’s on walking ability? Did you and your team talk about any suggestions as to how these compounding effects might be mediated? I know this is a tough question as both OA and Parkinsons can be devastating on a person’s ability to walk.

Justin Daniels
Justin Daniels (@guest_2176)
Reply to  Heather Gibson
1 year ago

Thank you Heather! I’ll try and answer your questions individually.

Yes, OA has known gait and mobility dysfunction that can overlap with the symptoms of PD.

The issue is that treatment options for PD and OA differ (PD treatments include carbidopa-levodopa and OA tends to be weight loss to reduce joint stress). Since treatments differ, we found it important to determine if there was an additive, negative impact that OA has on PD so that treatments may be directed to their specific causes.

Hope that answers your questions!

Heather Gibson
Heather Gibson (@guest_2644)
Reply to  Justin Daniels
1 year ago

Thanks for your responses Justin!! Much appreciated.

Daniel Moolchand
Daniel Moolchand (@guest_1704)
1 year ago

Hey Justin,

Really good presentation! What was the average age of your participants? Also, did you account for other movement disorders your participants? Again really good poster!

Justin Daniels
Justin Daniels (@guest_2302)
Reply to  Daniel Moolchand
1 year ago

Hey Daniel, of our 31 participants the average age was 71.

Brian Martinez
Brian Martinez (@guest_1754)
1 year ago

Great job on the poster! I liked your figures a lot. They made the poster easy to read and flow nicely.
How was your participant sample chosen?

Justin Daniels
Justin Daniels (@guest_2616)
Reply to  Brian Martinez
1 year ago

Hey Brian,

I appreciate the kind words! Our participants were recruited mostly by phone-call from a research database registry in collaboration with the Fixel Institute for Neurological Diseases.

Jordan Moumne
Jordan Moumne (@guest_1852)
1 year ago

Hi Justin,

How would these conclusions and future studies impact the care for people who have Parkinson’s? Very well put together presentation!

Justin Daniels
Justin Daniels (@guest_2960)
Reply to  Jordan Moumne
1 year ago

Hey Jordan,

Great question! If people were falsely attributing symptoms to Parkinson’s disease, treatments would be directed solely towards PD. If comorbid conditions are exacerbating these symptoms (such as OA), physicians would alter their treatments to generate a more effective outcome.

Lauren Weinsier
Lauren Weinsier (@guest_3930)
1 year ago

Hi Justin! Great visual! I noticed in your box plots, especially the one on double support, you had some outliers. Do you think these outliers affected your results? Also, what does this mean for the implications of your study?

Justin Daniels
Justin Daniels (@guest_7130)
Reply to  Lauren Weinsier
1 year ago

Hey Lauren, thank you for the kind words!

The outliers may have had an effect on the data, but we did not find it appropriate to remove them from the dataset as they may have been representative of a person with severe symptomology. As for what it means, that is hard to say. It may imply that since the “larger outlier” of the two had PD and comorbid OA that there can be cases of extreme impact of OA on PD. It would require a larger sample size to properly determine this.

Gina De Sanctis
Gina De Sanctis (@guest_5116)
1 year ago

Great presentation! Before reading your poster I was not aware of the impact that osteoarthritis has on those with Parkinson’s Disease.

Grace Kellaher
Grace Kellaher (@guest_5196)
1 year ago

Hi Justin,

Great job with your poster and presentation- way to represent the Applied Neuromechanics Lab!

In your PDOA group, did you at the breakdown of number of participants with unilateral vs bilateral knee OA? Since PD typically affects one side of the body more than the other, I’m curious to see if for those with PD and unilateral OA, their affected knee is the same as the side of their body more affected by PD.

Justin Daniels
Justin Daniels (@guest_7206)
Reply to  Grace Kellaher
1 year ago

Thank you Grace!

Great question. For this study, we did not separate unilateral vs bilateral knee OA. Our PDOA group consisted of a Kellgren-Lawrence grade of 2-4 in at least one knee. There are often differing grades between each knee and I think this is something future studies should certainly examine!