Michele Tinazzi1, Marialuisa Gandolfi2, Carlo Alberto Artusi3, Ruggero Lanzafame1, Elisabetta Zanolin4, Roberto Ceravolo5, Marianna Capecci6, Elisa Andrenelli6, Maria Gabriella Ceravolo6, Laura Bonanni7, Marco Onofrj7, Roberta Telese7, Claudio Bertolotti8, Paola Polverino8, Paolo Manganotti8, Sonia Mazzucchi5, Sara Giannoni5, Laura Vacca9, Fabrizio Stocchi9, Miriam Casali9, Maurizio Zibetti3, Leonardo Lopiano3, Alfonso Fasano10, Christian Geroin11. 1. Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy. 2. Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; Neurorehabilitation Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy. 3. Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy. 4. Department of Public Health and Community Medicine, University and Hospital Trust of Verona, 37134, Verona, Italy. 5. Department of Clinical and Experimental Medicine, University of Pisa, Italy. 6. Department of Experimental and Clinical Medicine, Neurorehabilitation Clinic, "Politecnica delle Marche" University, Ancona, AN, Italy. 7. Department of Neuroscience, Imaging and Clinical Sciences, University G.d'Annunzio of Chieti-Pescara, Italy. 8. Clinical Neurology Unit, Department of Medical, Surgical and Health services, University of Trieste, Italy. 9. University and Institute for Research and Medical Care IRCCS San Raffaele, Roma, Italy. 10. Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Krembil Brain Institute, Toronto, Ontario, Canada. 11. Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy. Electronic address: christian.geroin@univr.it.
Abstract
INTRODUCTION: Software-based measurements of postural abnormalities in Parkinson's disease (PD) are the gold standard but may be time-consuming and not always feasible in clinical practice. Wall goniometer (WG) is an easier, quicker, and inexpensive instrument for screening patients with postural abnormalities, but no studies have investigated its validity so far. The aim of this study was to investigate the validity of the WG to measure postural abnormalities. METHODS: A total of 283 consecutive PD outpatients with ≥5° forward trunk, lateral trunk or forward neck bending (FTB, LTB, FNB, respectively) were recruited from seven centers for movement disorders. Postural abnormalities were measured in lateral and posterior view using a freeware program (gold standard) and the WG. Both angles were expressed in degrees (°). Sensitivity and specificity for the diagnosis of camptocormia, Pisa syndrome, and anterocollis were assessed. RESULTS: WG showed good to excellent agreement (intraclass correlation coefficient from 0.80 to 0.98) compared to the gold standard. Bland-Altman plots showed a mean difference between the methods from -7.4° to 0.4° with limits of agreements from -17.7° to 9.5°. Sensitivity was 100% for the diagnosis of Pisa syndrome, 95.74% for anterocollis, 76.67% for upper camptocormia, and 63.64% for lower camptocormia. Specificity was 59.57% for Pisa syndrome, 71.43% for anterocollis, 89.80% for upper camptocormia, and 100% for lower camptocormia. Overall, the WG underestimated measurements, especially in lower camptocormia with an average of -8.7° (90% of cases). CONCLUSION: WG is a valid tool for screening Pisa syndrome and anterocollis, but approximately 10° more should be added for camptocormia.
INTRODUCTION: Software-based measurements of postural abnormalities in Parkinson's disease (PD) are the gold standard but may be time-consuming and not always feasible in clinical practice. Wall goniometer (WG) is an easier, quicker, and inexpensive instrument for screening patients with postural abnormalities, but no studies have investigated its validity so far. The aim of this study was to investigate the validity of the WG to measure postural abnormalities. METHODS: A total of 283 consecutive PD outpatients with ≥5° forward trunk, lateral trunk or forward neck bending (FTB, LTB, FNB, respectively) were recruited from seven centers for movement disorders. Postural abnormalities were measured in lateral and posterior view using a freeware program (gold standard) and the WG. Both angles were expressed in degrees (°). Sensitivity and specificity for the diagnosis of camptocormia, Pisa syndrome, and anterocollis were assessed. RESULTS: WG showed good to excellent agreement (intraclass correlation coefficient from 0.80 to 0.98) compared to the gold standard. Bland-Altman plots showed a mean difference between the methods from -7.4° to 0.4° with limits of agreements from -17.7° to 9.5°. Sensitivity was 100% for the diagnosis of Pisa syndrome, 95.74% for anterocollis, 76.67% for upper camptocormia, and 63.64% for lower camptocormia. Specificity was 59.57% for Pisa syndrome, 71.43% for anterocollis, 89.80% for upper camptocormia, and 100% for lower camptocormia. Overall, the WG underestimated measurements, especially in lower camptocormia with an average of -8.7° (90% of cases). CONCLUSION: WG is a valid tool for screening Pisa syndrome and anterocollis, but approximately 10° more should be added for camptocormia.
Authors: Christian Geroin; Carlo Alberto Artusi; Marialuisa Gandolfi; Elisabetta Zanolin; Roberto Ceravolo; Marianna Capecci; Elisa Andrenelli; Maria Gabriella Ceravolo; Laura Bonanni; Marco Onofrj; Roberta Telese; Giulia Bellavita; Mauro Catalan; Paolo Manganotti; Sonia Mazzucchi; Sara Giannoni; Laura Vacca; Fabrizio Stocchi; Miriam Casali; Cristian Falup-Pecurariu; Maurizio Zibetti; Alfonso Fasano; Leonardo Lopiano; Michele Tinazzi Journal: Front Neurol Date: 2020-03-31 Impact factor: 4.003