Article

Postural instability is a cardinal sign of idiopathic Parkinson's disease (IPD) leading to increased fall risk; however, the exact reason for this instability is unclear.
This systematic review critically explored the relationships between factors contributing to or impacting on postural instability in people with IPD.
Methods: Ten databases were searched for studies, with an experimental or observational design, which met the following criteria: (1) participants diagnosed with IPD; (2) included a measure or perturbation of postural stability or balance; and (3) investigated at least one factor contributing to or impacting on postural instability.
The Generic Appraisal Tool for Epidemiology (GATE) checklist was used to rate the methodological quality of selected studies.
Results: Fifty-seven studies were selected, of which 42 were rated to have moderate-to-high quality. Factors contributing to or impacting on postural instability were broadly categorized as: (1) sensory dysfunction (n?=?12); (2) abnormal postural response patterns (n?=?11); (3) bradykinesia (n?=?2); (4) stiffness (n?=?7); (5) cognitive function (n?=?5); and miscellaneous factors (n?=?5). From the studies rated as of high quality, five factors were identified to significantly impact on postural stability: sensory dysfunction, bradykinesia, abnormal postural response patterns, L-dopa induced dyskinesia, and hypotension (the latter two factors were categorized as 'miscellaneous').
Conclusions: Using a reductionist approach, this review identified five factors that appear to significantly impact on postural stability in IPD; however, this may be a simplistic summary and it is more likely that postural instability is a complex interplay of many factors. Further research is suggested to elucidate more fully the factors involved in postural instability.

Langue : ANGLAIS