Effect of Lower Limb vs. Abdominal Compression on Mobility in Orthostatic Hypotension: A Single-Blinded, Randomized, Controlled, Cross-Over Pilot Study in Parkinson’s Disease

Article type: Research Article

Authors: Paschen, Steffen^a | Hansen, Clint^a | Welzel, Julius^a | Albrecht, Judith^a | Atrsaei, Arash^c | Aminian, Kamiar^c | Zeuner, Kirsten E.^a | Romijnders, Robbin^a | Warmerdam, Elke^a | Urban, Paul Peter^b | Berg, Daniela^a | Maetzler, Walter^{a; *}

Affiliations: [a] Department of Neurology, Kiel University, Kiel, Germany | [b] Department of Neurology, Asklepios Klinik Barmbek, Hamburg, Germany | [c] Laboratory of Movement Analysis and Measurement, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland

Correspondence: [*] Correspondence to: Walter Maetzler, MD, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel and Kiel University, Arnold-Heller-Str. 3, Haus D, 24105 Kiel, Germany. Tel.: +49 431 500 23981; E-mail: w.maetzler@neurologie.uni-kiel.de.

Abstract: Background:Orthostatic hypotension (OH) in Parkinson’s disease (PD) is frequent and associated with impairments in quality of life and reduced activities of daily living. Abdominal binders (AB) and compression stockings (CS) have been shown to be effective non-pharmacological treatment options. Objective:Here, we investigate the effect of AB versus CS on physical activity using a digital mobility outcome (sit to stand [STS] frequency) collected in the usual environment as a primary endpoint. Methods:We enrolled 16 PD patients with at least moderate symptomatic OH. In a randomized, single-blinded, controlled, crossover design, participants were assessed without OH treatment over 1 week (baseline), then were given AB or CS for 1 week and subsequently switched to the other treatment arm. The primary outcome was the number of real-life STS movements per hour as assessed with a lower back sensor. Secondary outcomes included real-life STS duration, mean/systolic/diastolic blood pressure drop (BPD), orthostatic hypotension questionnaire (OHQ), PD quality of life (PDQ-39), autonomic symptoms (SCOPA-AUT), non-motor symptoms (NMSS), MDS-UPDRS, and activities of daily living (ADL/iADL). Results:Real-life STS frequency on CS was 4.4±4.1 per hour compared with 3.6±2.2 on AB and 3.6±1.8 without treatment (p = 1.0). Concerning the secondary outcomes, NMSS showed significant improvement with CS and AB. OHQ and SCOPA-AUT improved significantly with AB but not CS, and mean BPD drop worsened with CS but not AB. Mean STS duration, PDQ-39, MDS-UPDRS, ADL, and iADL did not significantly change. Conclusion:Both AB and CS therapies do not lead to a significant change of physical activity in PD patients with at least moderate symptomatic OH. Secondary results speak for an effect of both therapies concerning non-motor symptoms, with superiority of AB therapy over CS therapy.

Keywords: Abdominal binder, compression stockings, orthostatic hypotension, Parkinson’s disease, sit-to-stand, blood pressure drop

DOI: 10.3233/JPD-223406

Journal: Journal of Parkinson's Disease, vol. 12, no. 8, pp. 2531-2541, 2022