Does Pisa syndrome affect upper limb function in patients with Parkinson's disease? An observational cross-sectional study

Abstract

Background: Trunk alignment is thought to contribute to upper limb (UL) function. However, this common assumption is not clear in patients with Parkinson's Disease (PD) suffering from Pisa syndrome (PS). PS is a postural abnormality, characterized by revisable lateral trunk flexion more than 10 degrees.

Objective: To investigate the UL functioning and activities of daily living in PD patients with PS.

Methods: Forty-five participants distributed equally in three groups PD patients with PS, PD patients without PS and age/sex matched healthy controls (HC). The function and disability of UL was assessed by Arm Shoulder and Hand (DASH) questionnaire for all groups. PD groups then completed clinical assessments by the Unified Parkinson's Disease Rating Scale (UPDRS) part II-III, Modified Hoenh & Yahr (mH&Y) staging and the Levodopa Equivalent Daily Dose (LEDD).

Results: Three groups showed significant differences in DASH questionnaire (p < 0.001) with higher scores for PS group, intermediate for PD group and lower for HC group. PS group also showed higher score in UPDRS-II and mH&Y (p = 0.019), while no differences emerged between PD and PS in UPDRS-III score and LEDD.

Conclusion: Our results demonstrated that PS is associated with major impairment of both UL functioning and activities of daily living in PD patients.

Keywords: Parkinson’s disease; Pisa syndrome; axial bending; dystonia; lateral trunk flexion; rehabilitation; upper limb function.