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Can gait signatures provide quantitative measures for aiding clinical decision-making? A systematic meta-analysis of gait variability behavior in patients with Parkinson's disease

机译：步态信号可以为临床决策提供定量方法吗？帕金森氏病患者步态变异行为的系统荟萃分析

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A disturbed, inconsistent walking pattern is a common feature of patients with Parkinson's disease (PwPD). Such extreme variability in both temporal and spatial parameters of gait has been associated with unstable walking and an elevated prevalence of falls. However, despite their ability to discretise healthy from pathological function, normative variability values for key gait parameters are still missing. Furthermore, an understanding of each parameter's response to pathology, as well as the inter-parameter relationships, has received little attention. The aim of this systematic literature review and meta-analysis was therefore to define threshold levels for pathological gait variability as well as to investigate whether all gait parameters are equally perturbed in PwPD. Based on a broader systematic literature search that included 13'195 titles, 34 studies addressed Parkinson's disease, presenting 800 PwPD and 854 healthy subjects. Eight gait parameters were compared, of which six showed increased levels of variability during walking in PwPD. The most commonly reported parameter, coefficient of variation of stride time, revealed an upper threshold of 2.4% to discriminate the two groups. Variability of step width, however, was consistently lower in PwPD compared to healthy subjects, and therefore suggests an explicit sensory motor system control mechanism to prioritize balance during walking. The results provide a clear functional threshold for monitoring treatment efficacy in patients with Parkinson's disease. More importantly, however, quantification of specific functional deficits could well provide a basis for locating the source and extent of the neurological damage, and therefore aid clinical decision-making for individualizing therapies.
机译：帕金森氏病（PwPD）患者的常见特征是行走方式混乱，不一致。步态的时间和空间参数的这种极端可变性与不稳定的步行和高的跌倒发生率有关。然而，尽管它们具有使健康与病理功能分离的能力，但关键步态参数的规范变异性值仍然缺失。此外，对每个参数对病理反应以及参数间关系的了解很少受到关注。因此，本系统文献综述和荟萃分析的目的是确定病理性步态变异性的阈值水平，并研究PwPD中是否所有步态参数均受到同等干扰。在更广泛的系统文献检索（包括13'195个标题）的基础上，针对帕金森氏病的34项研究提出了800例PwPD和854例健康受试者。比较了八个步态参数，其中六个显示了PwPD行走过程中变异性的增加。最常报告的参数是步幅时间变化系数，揭示了区分这两组的上限2.4％。然而，与健康受试者相比，PwPD的步幅宽度始终较低，因此建议使用显式的感觉运动系统控制机制来优先考虑步行过程中的平衡。结果为监测帕金森氏病患者的治疗效果提供了明确的功能阈值。然而，更重要的是，对特定功能缺陷的量化可以很好地为定位神经损伤的来源和程度提供基础，从而有助于临床决策以个体化治疗。

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