Avaliação da potência vertical de membros inferiores em pessoas com Parkinson

Abstract

Parkinson's disease (PD) is considered neurodegenerative, polysomatic, and idiopathic, which affects the central nervous system, more precisely the dopaminergic neurons of the basal ganglia. The neural disorders of the disease cause neuromuscular declines, such as a reduction in motoneuron responses, potential action firing, muscle recruitment, power, strength, and muscle mass. Muscle power is fundamental in initiating movements, and its decline implies frailty, risk of falls, greater dependence, and low quality of life. In this context, it is relevant to evaluate muscle power in people with Parkinson's (PwP). However, using high- cost equipment that is difficult to transport and handle presents challenges for carrying out clinical assessments in this population. The evaluation of the vertical power of the lower limbs allows the interpretation of biomechanical mechanisms, such as strength, speed, and power. Clinically, the analysis of these aspects of Parkinson's disease is essential for rehabilitation strategies that emphasize the maintenance and improvement of these components. The literature reports that mobile applications are an alternative to specific instruments (for example, photoelectric cells, and goniometers). However, it is necessary to test the reproducibility and agreement of these instruments in populations with significant motor declines, such as individuals with Parkinson's disease (PD). Objective: To describe the vertical power of PcP through the performance of the vertical countermovement jump (CMJ) and evaluate the agreement in jump performance measurements by different evaluators (intra-evaluators) and between equipment (inter-instruments): a contact for vertical jumps and a My Jump 2® mobile app. Methods: The participants were 19 PwPs over 40 years old (15 men and 4 women), with PD staging between 1 and 3 according to the Hohn & Yearh Scale. The participants underwent clinical assessments: cognitive screening, anamnesis, and disease monitoring. For anthropometric assessments, we used a stadiometer, digital scale, and anthropometric tape measure. To assess performance, we used the CMJ vertical jump test, which was recorded simultaneously using the contact mat for vertical jumps and the My Jump 2® app installed on an IOS version 17.2 smartphone, recording at 240 Hz and 1080 HD. The volunteers were instructed to perform 3 consecutive jumps, with an interval of 120 seconds between each jump. For the statistical analysis, descriptive statistics were used to characterize the sample and then a mixed model was adjusted to assess the difference between the measurements. Next, the Bootstrap technique with 10,000 resamples was applied to calculate the limits of agreement, and histograms were generated to visualize the distribution of the Intraclass Correlation Coefficient (ICC). Finally, Bland-Altman plots were created to visualize the agreement between raters and instruments. All the intra-rater and later inter-instrument analyses were carried out using the R software. Results: As result, the values of ICC= 0.952 between evaluators and ICC= 0.948 between instruments indicate a very strong intra-evaluator and inter-instrument correlation. In both analyses, the limits of the confidence interval were close, with little variation in the estimates and reliability of the ICC. In the Bland-Altman analyses, there was agreement and consistency between assessors and instruments, with biases of 0.36 cm between assessors and -1.3 cm between instruments. Conclusion: Our results suggest that the My Jump 2® app is an alternative tool for assessing lower limb power using the CMJ vertical jump test in people with Parkinson's disease.