Evidence of slow and variable choice-stepping reaction time in cancer survivors with chemotherapy-induced peripheral neuropathy,Gait & Posture

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Evidence of slow and variable choice-stepping reaction time in cancer survivors with chemotherapy-induced peripheral neuropathy
Gait & Posture ( IF 2.4 ) Pub Date : 2021-07-21 , DOI: 10.1016/j.gaitpost.2021.07.010
J C Menant ₁ , D Goldstein ₂ , K Au ₃ , T Trinh ₃ , K S van Schooten ₁ , J M McCrary ₄ , C A Harris ₅ , B C Forster ₆ , S B Park ₇

Affiliation

Neuroscience Research Australia, University of New South Wales, New South Wales, Australia; School of Population Health, University of New South Wales, New South Wales, Australia.
Prince of Wales Clinical School, University of New South Wales, Kensington, Australia; Dept. of Medical Oncology, Prince of Wales Hospital, Randwick, Australia.
Prince of Wales Clinical School, University of New South Wales, Kensington, Australia.
Prince of Wales Clinical School, University of New South Wales, Kensington, Australia; Institute of Music Physiology and Musicians' Medicine, Hannover University of Music Drama, and Media, Hannover, Germany.
Dept. of Medical Oncology, St George Hospital, Kogarah, Australia; St George and Sutherland Clinical School, University of New South Wales, Australia.
Dept. of Medical Oncology, The Mater Hospital, North Sydney, Australia; Northern Clinical School, The University of Sydney, St Leonards, New South Wales, Australia.
Prince of Wales Clinical School, University of New South Wales, Kensington, Australia; Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia.

Background

Chemotherapy-induced peripheral neuropathy (CIPN) is reported to affect up to 70 % of cancer survivors. Despite evidence that CIPN-related impairments often translate into balance and mobility deficits, the effects on stepping and quality of gait, well-documented risk factors for falls, are unclear.

Aims

(i) Establish choice-stepping reaction time (CSRT) performance in survivors with CIPN compared to young and older healthy controls and people with Parkinson’s disease; (ii) document walking stability; (iii) investigate relationships between stepping and gait data to objective and patient-reported outcomes.

Methods

41 cancer survivors with CIPN (mean (SD) age: 60.8 (9.7) years) who were ≥3months post chemotherapy, performed tests of simple and inhibitory CSRT. Walking stability measures were derived from 3-D accelerometry data during the 6-minute walk test. CIPN was assessed using neurological grading and patient-reported outcome measures (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire in CIPN Questionnaire scale EORTC CIPN20).

Results

In both stepping tests, CIPN participants performed at the level of adults aged 10 years older and people with mild to moderate Parkinson’s disease. Mean (SD) total stepping response times in both CSRT (1160 (190) milliseconds) and inhibitory CSRT (1191 (164) milliseconds) tests were not associated with objective neurological grading but were correlated with increased difficulty feeling the ground. Participants with lower-limb vibration sensation deficit had slower and more variable CSRT times. There were no associations between walking stability and objective measures of CIPN, and limited correlations with the EORTC-CIPN20.

Conclusions

Cancer survivors with CIPN showed deficits in voluntary stepping responses and seemed to compensate for their sensory and motor deficits by walking slower to maintain stability. Objective and patient-reported outcomes of CIPN were correlated with slower and more variable stepping response times. Future studies should aim to identify the causes of the apparent premature decline in cognitive-motor function and develop remediating interventions.

中文翻译：

化疗引起的周围神经病变的癌症幸存者的缓慢和可变的选择步进反应时间的证据

背景

据报道，化疗引起的周围神经病变 (CIPN) 影响多达 70% 的癌症幸存者。尽管有证据表明 CIPN 相关的损伤通常会转化为平衡和行动能力的缺陷，但对步态和步态质量的影响，以及有据可查的跌倒风险因素，尚不清楚。

宗旨

(i) 与年轻和年长的健康对照者和帕金森病患者相比，确定 CIPN 幸存者的选择步进反应时间 (CSRT) 表现；(ii) 记录行走稳定性；(iii) 调查步进和步态数据与客观和患者报告结果之间的关系。

方法

41 名 CIPN 癌症幸存者（平均 (SD) 年龄：60.8 (9.7) 岁）化疗后≥3 个月，进行了简单和抑制性 CSRT 测试。步行稳定性测量来自 6 分钟步行测试期间的 3-D 加速度测量数据。CIPN 使用神经学分级和患者报告的结果测量（欧洲癌症研究和治疗组织在 CIPN 问卷量表中的生活质量问卷 EORTC CIPN20）进行评估。

结果

在这两项步进测试中，CIPN 参与者在 10 岁以上的成年人和轻度至中度帕金森病患者的水平上进行了测试。CSRT（1160 (190) 毫秒）和抑制性 CSRT（1191 (164) 毫秒）测试中的平均 (SD) 总步进响应时间与客观神经学分级无关，但与感觉地面的难度增加相关。下肢振动感觉缺陷的参与者的 CSRT 时间更慢且变化更大。步行稳定性与 CIPN 的客观测量之间没有关联，并且与 EORTC-CIPN20 的相关性有限。