Objective: The mechanisms of postural abnormalities in Parkinson’s disease are diverse but often intractable, and there are no established measures to prevent early-stage progression.

Background: This study prospectively investigated by long-term observation of subjects with PD whether the angle at the position subjectively recognized as vertical by the subject (subjective vertical posture: SV angle) exacerbates the forward flexion of trunk (FFT) angle in the static standing position.

Method: Patients consenting to this study at 13 institutions in Japan were prospectively observed for 1 year from September 2019 to March 2021. Posture evaluation by measurement of the FFT angle, trunk lateral flexion (LFT) angle, and SV angle was performed at the initial observation and at 6 and 12 months later. There were no drug restrictions during the observation period. From the obtained data, we analyzed both the relationship between the initial SV angle and the FFT angles at 6 and 12 months later and the factors that affected the FFT angles at 12 months later.

Results: This study enrolled 180 patients (mean age 71.2 years, male 50.5%, mean disease duration 76.8 months, Hoehn-Yahr severity 2.4, levodopa dose 522 mg/day, rate of dopamine agonist use 52%). The coefficient of variance of both SV angle and forward bending angle were less than 25% at each measurement point. Compared to their initial angles, SV angle significantly worsened at 6 and 12 months (P<0.05), but FFT significantly worsened only after 6 months (P=0.004), and lateral flexion of the trunk remained unchanged during the observation course. MDS-UPDRS Part III score remained unchanged throughout the course, but the total levodopa-equivalent dose had increased significantly at 6 and 12 months (P=0.001). There was a significant correlation between the difference in SV angle and that in the flexion angle at the initial and 12-month evaluations (r=0.56, P=0.001). Factors affecting FFT angle after 12 months by multiple regression analysis included initial SV (P=001), initial UPDRS score (P=0.013), and difference in SV between the initial and 12-month evaluation (P=0.003).

Conclusion: Evaluation of SV may be useful in predicting the prognosis of progression of the FFT angle, and it is expected that rehabilitation programs can be planned based on the SV in the future

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effect-of-recognition-of-vertical-posture-on-forward-bending-posture-in-patients-with-parkinsons-disease-a-multicenter-observational-study/