Functional mobility in Parkinson’s disease

Introduction: Parkinson’s disease (PD) is the second most common neurodegenerative disease, affecting 1% of the world population over the age of 60. The presence of a large and heterogeneous spectrum of motor and non-motor symptoms, some resistant to levodopa therapy, is usually a major source of disability that affects patients’ daily activities and social participation. Functional mobility (FM) is an outcome that merges the concepts of function with mobility, autonomy, and the accomplishment of daily tasks in different environments. Its use in PD studies is common. However, several aspects associated with its application in PD remain to be defined, hampering a wider use of the concept in clinical practice and the comparison of clinical study results. Aim: This thesis aimed to provide evidence on the appropriateness of the concept of FM in the PD field. A two-fold approach was used to this end: 1) To investigate the clinical and research applicability of the concept of FM in PD; 2) To identify the most suitable clinical and technological outcome measures for evaluating the response of PD patients’ FM to a therapeutic intervention. Methods: A narrative review using the framework of the International Classification of Functioning, Disability, and Health (ICF) was performed to explore the concept of FM when applied to PD. This first study aimed to provide a better understanding of the interaction between PD symptoms, FM, and patients’ daily activities and social participation. To identify and recommend the most suitable outcome measures to assess FM in PD, a systematic review was conducted using the CENTRAL, MEDLINE, Embase, and PEDro databases, from their inception to January 2019. During this review, we also explored the different definitions of FM present in the literature, proposing the one we believed should be established as the definition of FM in the PD field. We then conducted a focus group to explore PD patients' and health professionals’ perspectives on the proposed definition. Part of the scope of the focus group was also to investigate the impact of FM problems on patients’ daily living and the strategies used to deal with this. The study included four focus groups, two with patients (early and advanced disease stages), and two with health professionals (neurologists and physiotherapists). A second systematic review using the CENTRAL, MEDLINE, Embase, and PEDro databases, from their inception to September 2019, was performed to summarize and critically appraise the published evidence on PD spatiotemporal gait parameters. Finally, a pragmatic clinical study was conducted to identify the clinical and technological outcome measures that better predict changes in FM, when patients are submitted to a specialized multidisciplinary program for PD. Results: All the definitions found in an open search of the literature on the FM concept included three key aspects: gait, balance, and transfers. All participants in the focus group study were able to present a spontaneous definition of FM that matched the one used by the authors. All also agreed that FM reflects the difficulties of PD patients in daily life activities. Early-stage PD patients mentioned needing more time to complete their usual tasks, while advanced-stage PD patients considered FM limitations as the main limiting factor of daily activities, especially in medication “OFF” periods. Physiotherapists maintained that the management of PD FM limitations should be a joint work of the multidisciplinary team. For neurologists, FM may better express patients’ perception of their overall health status and may help to adopt a more patient-centered approach. Of the 95 studies included in the systematic review aiming to appraise the outcome measures that have been used to assess FM in PD patients, only one defined the concept of FM. The most frequent terms used as synonyms of FM were mobility, mobility in association with functional activities/performance, motor function, gait-related activity, or balance. In the literature, the Timed Up and Go (TUG) test was the most frequently reported tool used as a single instrument to assess FM in PD. The changes from baseline in the TUG Cognitive test, step length, and free-living step time asymmetry were identified as the best predictors of TUG changes. Conclusion: The information generated by the different studies included in this thesis revealed FM as a useful concept to be adopted in the PD field. FM was shown to be a meaningful outcome (for patients and health professionals), easy to measure, and able to provide more global and ecological information on patients’ daily living performances. Our results support the use of FM for PD assessment and free-living monitoring, as a way to better understand and address patients’ needs. The changes in the TUG Cognitive test, the supervised step length, and the free-living step time asymmetry seem the most suitable outcomes to measure an effect in FM. Future research should focus on determining the severity cut-off for FM changes, the minimal clinical important difference (MCID) for each of these outcome measures and resolve the current obstacles to the widespread use of technological assessments in PD clinical practice and research

Assessment of methodological characteristics and quality reporting of clinical trials in palliative care

Tese de mestrado, Cuidados Paliativos, Universidade de Lisboa, Faculdade de Medicina, 2016Background Over the past decades there has been a significant increase in the number of published clinical trials in palliative care. However, empirical evidence suggests that there are problems with the design of these clinical trials, which in turn raises questions about the validity of their findings and the strength of the available evidence. Aims To evaluate the methodological characteristics and assess the quality of reporting of clinical trials in palliative care. Methods We performed a systematic review of published clinical trials assessing therapeutic interventions in palliative care. Trials were identified using MEDLINE (from its inception to February 2015). We assessed methodological characteristics and describe the quality of reporting using Cochrane Risk of Bias tool. Results We retrieved 107 studies. The most common medical field studied was oncology. Regarding type of intervention 43,93% trials evaluated pharmacological interventions. Symptoms control and physical dimension were the palliative care specific issues most studied. In quality of reporting there is information missing, especially in respect to sequence generation, allocation concealment and blinding. Conclusions While the number of clinical trials in palliative care has increased with time, methodological quality remains suboptimal. This compromises the quality of studies. Therefore, a greater effort is needed to enable the appropriate performance of future studies and increase the robustness of evidence-based medicine in this important field.Contextualização Os cuidados paliativos têm como objectivo a prestação de cuidados à pessoa como um todo, através do controlo de sintomas e da integração de aspectos psicológicos e espirituais na assistência ao doente, promovendo a qualidade de vida e morte, sem a antecipar ou adiar. Este conceito foi utilizado pela primeira vez em 1973, por Balfour Mount. Desde então, sofreu uma série de transformações na sua definição e consequentemente na sua área de atuação e objectivos. A Organização Mundial de Saúde, autora das duas definições mais utilizadas, afirmou em 1990, que a população alvo de cuidados paliativos era composta pelos pacientes cujo a doença não respondia ao tratamento curativo e mais tarde, em 2002, a população alvo passou a incluir também os familiares de doentes com uma doença que ameaçasse a vida. Desde a abertura, em 1969, do St. Christopher Hospice, o primeiro hospice sediado em Londres, esteve presente a noção do papel crucial da investigação clínica como forma de demonstrar a eficácia terapêutica dos cuidados paliativos. Segundo uma pesquisa na OVID MEDLINE, entre 1970 e 2005 o número de artigos publicados nesta área quadriplicou. Em 2006, a medicina paliativa foi reconhecida nos Estados Unidos como subespecialidade, tornando-se mandatário a adopção de pontos-chave standard já aplicados noutras especialidades e subespecialidades médicas, tais como: avaliação dos métodos e raciocínio clínico na tomada de decisão, a identificação de obstáculos para execução de uma prática baseada na evidência e desenvolvimento de estratégias para contornar os mesmos e uma atualização da prática clínica e investigacional de forma a coincidir com os parâmetros de alta qualidade da medicina baseada na evidência. Atualmente existe uma vasta gama de intervenções terapêuticas disponíveis, exigindo dos profissionais de saúde a capacidade de avaliar criticamente a evidência e de aplicá-la corretamente na prática clinica. As revisões sistemáticas são consideradas como o gold standard da evidência para orientar a prática clínica, uma vez que agregam de forma metódica, explícita e passíveis de reprodução uma coleção abrangente de estudos relevantes para a questão em estudo. A forma como um ensaio aleatorizado e controlado é conduzido pode estar sujeita a enviesamentos, isto é, erros sistemáticos que dão origem a desvios da verdade nos resultados ou inferências. Como consequência, é de extrema importância a avaliação da qualidade dos estudos originais, aquando da realização de uma revisão sistemática. Muitas ferramentas, em diferentes áreas da saúde, têm sido propostos para este fim. Em 2011 a Cochrane propôs uma nova abordagem à avaliação da qualidade, associando o conceito de qualidade dos estudos à sua validade interna, ou seja, ao risco de viés. Desenvolveu, desta forma, uma ferramenta com base num crescente corpo de evidência empírica quantificando a associação entre determinadas características do estudo e a estimativa de efeito dos tratamentos. Esta é composta por duas partes e avalia sete domínios: geração da sequência de aleatorização, ocultação da alocação, ocultação de participantes e profissionais, ocultação de avaliadores, resultados incompletos, relato seletivo de resultados e outras fontes de viés . A primeira parte da ferramenta refere-se à descrição do que foi relatado no estudo, detalhado o suficiente para que a avaliação seja tomada com base nesta informação; a segunda parte avalia o risco de viés para cada uma das áreas analisadas atribuindo uma classificação de três níveis: baixo, alto ou risco de viés incerto. Objectivos Avaliar as características metodológicas e qualidade do reportar nos ensaios clínicos na área dos cuidados paliativos. Métodos Ensaios clínicos de intervenções na área dos cuidado paliativos foram procurados por pesquisa electrónica através da base de dados OVIDMEDLINE, desde o início até Fevereiro de 2015. Para tal foi utilizada uma estratégia pré-definida pelos autores em conjunto com o filtro da Cochrane, The Cochrane Collaboration’s highly sensitive search strategy. Na seleção de artigos foram considerados os seguintes critérios de inclusão: intervenção paliativa em doentes e/ou familiares/cuidadores, acesso ao resumo e versão integral do artigo e a presença de um grupo de controlo. Com base nas versões integrais dos artigos selecionados, dois autores de forma independente, procederam à recolha dos dados. Para tal, foi construída uma grelha de recolha de dados composta por 43 itens, baseada no consenso dos autores sobre os tópicos que consideravam relevante. Seis domínio foram tidos em conta: informação geral (título, nome e país do autor de correspondência, língua de publicação, ano e jornal de publicação, factor de impacto do jornal, área e tipo de intervenção, dimensão da pessoa e aspecto chave da prática dos cuidados paliativos, aprovação ética e consentimento informado), métodos (critérios de elegibilidade, tipo de desenho do estudo, método de randomização, presença de ocultação da aleatorização, tipo de ocultação e duração do follow-up), amostra (intervenção, número total de doentes aleatorizados e por grupo, duração e timming da intervenção, desistências e cálculo da amostra), análise dos dados (tipo de análise, métodos estatísticos utilizados, objectivos pré-definidos, instrumentos de avaliação e comparabilidade dos grupos), resultados. Os artigos incluídos foram divididos em domínio clínicos e tipos de intervenção. Foram considerados quatro tipos de intervenção: farmacológica, não farmacológica, não farmacológica – terapias complementares (tais como fisioterapia, musicoterapia, aromoterapia) e cuidado no domicílio (podendo este incluir intervenções farmacológicas e não farmacológicas). Dividimos também os estudos de acordo com pontos-chave da prática dos cuidados paliativos. Numa primeira divisão, tendo em conta a abordagem holística da pessoa, dividimos os estudos de acordo com as dimensões da pessoa: física, psicológica, social, espiritual, mais relacionada com a intervenção em estudo. A segunda divisão foi feita com base nos restantes pilares da prática dos cuidados paliativos: comunicação, controlo de sintomas, apoio à família e cuidadores e trabalho em equipa. Resultados A pesquisa electrónica identificou 939 citações, das quais 120 potencialmente elegíveis. A aplicação dos critérios de inclusão resultou na exclusão de 13 estudos. As principais razões de exclusão foram: repetição na lista de referências (n=3), dupla publicação (n=8) e a língua de publicação (n=2). Os resultados revelaram que os CT continuam a ser uma minoria na área dos cuidados paliativos. No entanto verificou-se um aumento do seu número ao longo dos anos, sendo a maioria dos Estados Unidos e Reino Unido (26,2% e 21,5%, respectivamente). A oncologia foi a área médica com mais estudos (56,1%, n=60) e 43,9% (n=47) avaliam intervenções farmacológicas. A dimensão física e o controlo sintomático foram os temas específicos da área dos cuidados paliativos mais estudados. O tipo de comparador mais usado foi a não intervenção/melhor cuidado de suporte (46.7%, n=50), usado maioritariamente em estudos com intervenções não farmacológicas. Em estudos de intervenções farmacológicas o comparador utilizado com maior frequência foi outra intervenção (droga ativa já testada e usada na prática clínica; 88,9%). O cálculo da amostra não foi reportado em 46,7% dos estudos incluídos e taxa de desistências foi superior a 20% do total da amostra em 40,2% dos estudos. Na análise da qualidade do reportar há uma percentagem significativa de informação em falta, especialmente nos domínios do geração da sequência, ocultação da distribuição, ocultação dos doentes, investigadores e avaliadores. Conclusões Nas últimas décadas a esperança média de vida aumentou e com ela o número de pessoas que sofrem de doenças crónicas. Isto torna a investigação na área dos cuidados paliativos ainda mais necessária. Não basta publicar mais, a qualidade da evidência deve acompanhar este crescimento. Os estudos observacionais são de grande utilidade na identificação, por exemplo, da relação entre características do doente e sintomas. No entanto, estudos experimentais e de alta qualidade como os RCT, com menor risco de viés e de factores de confundimento, melhoram o nível da evidência. Verificou-se, nos últimos anos, um aumento do número de ensaios clínicos na área dos cuidados paliativos. No entanto a sua qualidade continua baixa, comprometendo a qualidade de possíveis revisões. Torna-se assim patente a necessidade de um maior esforço para promover um adequado nível de qualidade em estudos futuros e, para tal, distinguir quais as barreiras passíveis de mudança e aquelas que são baseados em percepções, podendo não ser totalmente precisas. Atualmente, entre os obstáculos a ultrapassar encontra-se a necessidade de definir de forma mais uniforme o léxico específico da área dos cuidados paliativos e a sua população e de diversificar os estudos no que diz respeito ao domínio clínico, tipo de intervenção e ponto-chave dos cuidados paliativos abordado. Amostras maiores e novas estratégias, como estudos fast-track ou a utilização mais frequente da análise segundo intenção de tratar, podem ser o caminho para a obtenção de ensaios de maior qualidade

What is functional mobility applied to Parkinson’s disease?

© 2018 – IOS Press and the authors. All rights reserved. This article is published online with Open Access and distributed under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC 4.0).Although yet poorly defined and often misused, the concept of functional mobility has been used in research studies as a more global and ecological outcome of patients’ health status. Functional mobility is a person’s physiological ability to move independently and safely in a variety of environments in order to accomplish functional activities or tasks and to participate in the activities of daily living, at home, work and in the community. Parkinson’s disease (PD) has a direct impact on patients’ motor control and on mobility in general. Even with optimal medical management, the progression of PD is associated with mounting impairments at different levels of body function, causing marked limitations in a wide variety of activities, as well as a severe disability and loss of autonomy. Despite this, for everyday functioning PD patients need to have a good functional mobility that allow them to get around effortlessly in a reasonable amount of time to access to the same environments as others. This paper reviewed the concept of functional mobility applied to PD. This was done through an International Classification of Functioning and Disability (ICF) perspective. Recommendations to address the known factors that contribute to a poor functional mobility were outlined while suggestions for clinical practice and research were made.info:eu-repo/semantics/publishedVersio

Kinematic and clinical outcomes to evaluate the efficacy of a multidisciplinary intervention on functional mobility in Parkinson's disease

Copyright © 2021 Bouça-Machado, Branco, Fonseca, Fernandes, Abreu, Guerreiro, Ferreira and The CNS Physiotherapy Study Group. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.Introduction: Functional mobility (FM) is a concept that incorporates the capacity of a person to move independently and safely to accomplish tasks. It has been proposed as a Parkinson's disease (PD) functional and global health outcome. In this study, we aimed to identify which kinematic and clinical outcomes changes better predict FM changes when PD patients are submitted to a specialized multidisciplinary program. Methods: PD patients engaged in a pre-defined specialized multidisciplinary program were assessed at admission and discharge. Change from baseline was calculated for all kinematic and clinical outcomes, and Timed Up and Go (TUG) was defined as the primary outcome for FM. A stepwise multivariate linear regression was performed to identify which outcome measures better predict TUG changes. Results: Twenty-four patients were included in the study. The changes in TUG Cognitive test, supervised step length, and free-living (FL) step time asymmetry were identified as the best predictors of TUG changes. The supervised step length and FL step time asymmetry were able to detect a small to moderate effect of the intervention (d values ranging from -0.26 to 0.42). Conclusions: Our results support the use of kinematic outcome measures to evaluate the efficacy of multidisciplinary interventions on PD FM. The TUG Cognitive, step length, and FL step time asymmetry were identified as having the ability to predict TUG changes. More studies are needed to identify the minimal clinically important difference for step length and FL step time asymmetry in response to a multidisciplinary intervention for PD FM.The authors would like to acknowledge the support of Fundação para a Ciência e a Tecnologia (FCT) (SFRH/BD/120773/2016 to RB-M; SFRH/BD/144242/2019 to DB, UIDB/00408/2020 and UIDP/00408/2020 to LASIGE).info:eu-repo/semantics/publishedVersio

Risk of drowning in people with Parkinson's disease

© 2018 International Parkinson and Movement Disorder SocietySwimming is a common activity, practiced by both healthy and nonhealthy people of all ages. It is a complex activity that requires coordination of breathing with continued and harmonic upper and lower limb movements. Because of the unique properties of water, aquatic activities are usually associated with facilitated movements and therapeutic properties.info:eu-repo/semantics/publishedVersio

Measurement tools to assess activities of daily living in patients with Parkinson’s disease: A systematic review

Introduction: Parkinson's disease (PD) is associated with a progressive inability to accomplish essential activities of daily living (ADL) resulting in a loss of autonomy and quality of life. Accurate measurement of ADL in PD is important to monitor disease progression and optimize care. Despite its relevance, it is still unclear which measurement instruments are the most suitable for evaluating ADL in people with PD. Objective: To identify and critically appraise which measurement instruments have been used to assess ADL in PD. Methods: A systematic review was conducted using the databases CENTRAL, MEDLINE, and PEDro from their inception to October 2021 to identify all observational and experimental studies conducted in PD or atypical parkinsonism that included an ADL assessment. Titles and abstracts were screened independently by two authors. The clinimetric properties of the measurement instruments were assessed, and the instruments were classified as "recommended, " "suggested, " or "listed. " Results: A total of 129 articles were included, with 37 measurement instruments used. The Unified Parkinson's Disease Rating Scale (UPDRS), the Schwab & England ADL scale (S & E scale), the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS), the Barthel Index, the Lawton-Brody Instrumental Activities of Daily Living Scale, the Functional Independence Measure (FIM) and the Alzheimer's Disease Cooperative Study - ADL (ADCS-ADL) scale were the seven most frequently cited measurement instruments. Of these, only two included an assessment of basic and instrumental ADL. Conclusion: MDS-UPDRS and the S & E scale were the only two scales that could be classified as recommended. For the MDS-UPDRS, either the full version or only Part II, which is focused on ADL, can be used. Future studies should explore the use of wearable devices to assess ADL remotely and more continuously.info:eu-repo/semantics/publishedVersio

Clinical trials in palliative care : a systematic review of their methodological characteristics and of the quality of their reporting

© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background: Over the past decades there has been a significant increase in the number of published clinical trials in palliative care. However, empirical evidence suggests that there are methodological problems in the design and conduct of studies, which raises questions about the validity and generalisability of the results and of the strength of the available evidence. We sought to evaluate the methodological characteristics and assess the quality of reporting of clinical trials in palliative care. Methods: We performed a systematic review of published clinical trials assessing therapeutic interventions in palliative care. Trials were identified using MEDLINE (from its inception to February 2015). We assessed methodological characteristics and describe the quality of reporting using the Cochrane Risk of Bias tool. Results: We retrieved 107 studies. The most common medical field studied was oncology, and 43.9% of trials evaluated pharmacological interventions. Symptom control and physical dimensions (e.g. intervention on pain, breathlessness, nausea) were the palliative care-specific issues most studied. We found under-reporting of key information in particular on random sequence generation, allocation concealment, and blinding. Conclusions: While the number of clinical trials in palliative care has increased over time, methodological quality remains suboptimal. This compromises the quality of studies. Therefore, a greater effort is needed to enable the appropriate performance of future studies and increase the robustness of evidence-based medicine in this important field.info:eu-repo/semantics/publishedVersio

Feasibility of a mobile-based system for unsupervised monitoring in Parkinson’s disease

© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).Mobile health (mHealth) has emerged as a potential solution to providing valuable ecological information about the severity and burden of Parkinson's disease (PD) symptoms in real-life conditions. Objective: The objective of our study was to explore the feasibility and usability of an mHealth system for continuous and objective real-life measures of patients' health and functional mobility, in unsupervised settings. Methods: Patients with a clinical diagnosis of PD, who were able to walk unassisted, and had an Android smartphone were included. Patients were asked to answer a daily survey, to perform three weekly active tests, and to perform a monthly in-person clinical assessment. Feasibility and usability were explored as primary and secondary outcomes. An exploratory analysis was performed to investigate the correlation between data from the mKinetikos app and clinical assessments. Results: Seventeen participants (85%) completed the study. Sixteen participants (94.1%) showed a medium-to-high level of compliance with the mKinetikos system. A 6-point drop in the total score of the Post-Study System Usability Questionnaire was observed. Conclusions: Our results support the feasibility of the mKinetikos system for continuous and objective real-life measures of a patient's health and functional mobility. The observed correlations of mKinetikos metrics with clinical data seem to suggest that this mHealth solution is a promising tool to support clinical decisions.info:eu-repo/semantics/publishedVersio

Validation of quantitative gait analysis systems for Parkinson’s disease for use in supervised and unsupervised environments

© The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.Background: Gait impairments are among the most common and impactful symptoms of Parkinson’s disease (PD). Recent technological advances aim to quantify these impairments using low-cost wearable systems for use in either supervised clinical consultations or long-term unsupervised monitoring of gait in ecological environments. However, very few of these wearable systems have been validated comparatively to a criterion of established validity. Objective: We developed two movement analysis solutions (3D full-body kinematics based on inertial sensors, and a smartphone application) in which validity was assessed versus the optoelectronic criterion in a population of PD patients. Methods: Nineteen subjects with PD (7 female) participated in the study (age: 62 ± 12.27 years; disease duration: 6.39 ± 3.70 years; HY: 2 ± 0.23). Each participant underwent a gait analysis whilst barefoot, at a self-selected speed, for a distance of 3 times 10 m in a straight line, assessed simultaneously with all three systems. Results: Our results show excellent agreement between either solution and the optoelectronic criterion. Both systems differentiate between PD patients and healthy controls, and between PD patients in ON or OFF medication states (normal difference distributions pooled from published research in PD patients in ON and OFF states that included an age-matched healthy control group). Fair to high waveform similarity and mean absolute errors below the mean relative orientation accuracy of the equipment were found when comparing the angular kinematics between the full-body inertial sensor-based system and the optoelectronic criterion. Conclusions: We conclude that the presented solutions produce accurate results and can capture clinically relevant parameters using commodity wearable sensors or a simple smartphone. This validation will hopefully enable the adoption of these systems for supervised and unsupervised gait analysis in clinical practice and clinical trials.info:eu-repo/semantics/publishedVersio

Patients and health professional's perspective of functional mobility in Parkinson's Disease

Copyright © 2020 Bouça-Machado, Gonçalves, Lousada, Patriarca, Costa, Nunes, Dias, Caldas, Valadas, Lobo, Guedes, Rosa, Coelho and Ferreira. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.Background: Functional mobility (FM) is the person's ability to move to accomplish daily living tasks and activities. FM limitations are common in Parkinson's disease, increase with disease progression, and can be highly disabling. Although several studies in Parkinson's disease (PD) field use this concept, only recently, a formal definition has been proposed. Objective: We aimed to explore patient's and health professional's perspectives of FM in PD. Methods: A focus group methodology has been used. Four focus groups, with a total of 10 patients and 10 health professionals, were performed. Six patients were early stage and four advanced stage. The health professional's group was composed of five neurologists and five physiotherapists. The suitability of the new concept, the impact of FM limitations in PD patient's daily routine, and the potential benefit of walking aids have been discussed. Results: All participants were able to provide a spontaneous definition of FM, matching with the proposed concept. All agreed that PD affects patient's FM, increasing the limitations with disease progression, and with the existence of a serious prejudice with walking aids that hinders its use. Early-stage patient's perspective seems to be more in line with neurologist's perspective, while the views of advanced-stage patients were closer to physiotherapist's views. Conclusion: FM concept was considered as intuitive and useful. FM limitations have an important physical and social impact in the advanced stage of the disease. Although patients and health professionals acknowledge walking aid's benefit improving patient's FM, the prejudice associated with this type of tools limits its recommendation and use.The authors would like to thank to the Fundação para a Ciência e a Tecnologia (FCT) (SFRH/BD/120773/2016 to RB-M).info:eu-repo/semantics/publishedVersio