Objective: To investigate the motor and cognitive factors contributing to time to get out of bed in patients with Parkinson’s Disease (PD).

Background: The majority of PD patients experience difficulties with bed mobility which is a prerequisite for functional independence. However, the reasons for these problems have not been considered. Therefore, we aimed to uncover determinants of time to get out of bed (GB-Time) in PD.

Methods: 12 PD patients (age 71.6 ± 9.1 years, 9 females, H&Y 2-4) were asked to come from supine to sitting at their preferred side of the bed as quickly as possible. Trials were videotaped and fastest time measured while patients were ON medication. Measures of disease severity, cognitive ability, 10m walk time, and isometric muscles strength of the large lower limb muscles were assessed manually. Ratios were calculated of muscle strength between more-affected / less-affected side and between flexor and extensors of the lower limbs. Spearman’s rank correlations and a multivariable linear regression model were used to investigate the determinants of GB-Time.

Results: During performance, the observed GB-Time was 10.8s (± 8.4) on average and patients used a variety of movement strategies. Correlation analyses showed that GB-time was positively correlated with the 10m walk time (r = 0.67), arm rigidity at the most affected side (r = 0.62) and negatively with strength of the hip abductors (r = -0.58). As for muscular balance, GB-time was positively correlated with hamstrings-quadriceps ratio （r = 0.75), meaning that relatively greater hamstring involvement indicated slower bed movement. Ratios between sides were negatively correlated with GB-time in hip flexors (r = -0.58) and adductors (r = -0.61), meaning that when the dominant side was relatively weak, performance was slower. Further, cognitive performance on MMSE (r = -0.59) and FAB (r = -0.61) were also negatively correlated with GB-time. Backward linear regression revealed that muscular balance of hip flexors (β = -13.3, p = 0.003) and rigidity of the affected arm (β = 5.02, p = 0.005) explained 78% of variability in GB-Time.

Conclusions: This pilot study shows that muscle balance between the hip flexors of the more- and less-affected sides and rigidity in the more-affected arm have opposing effects on bed mobility, and predict time to get out of bed. Future research should investigate whether training aimed at improving these measures translate to improved bed mobility OFF medication.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/determinants-of-bed-mobility-proficiency-in-patients-with-parkinsons-disease-a-pilot-study/