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The effects of anxiety and external attentional focus on postural control in patients with Parkinson’s disease.

The effects of anxiety and external attentional focus on postural control in patients with Parkinson’s disease.
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Jazaeri SZ, Azad A, Mehdizadeh H, Habibi SA, Mandehgary Najafabadi M, Saberi ZS, Rahimzadegan H, Moradi S, Behzadipour S, Parnianpour M, Taghizadeh G, Khalaf K,


Jazaeri SZ, Azad A, Mehdizadeh H, Habibi SA, Mandehgary Najafabadi M, Saberi ZS, Rahimzadegan H, Moradi S, Behzadipour S, Parnianpour M, Taghizadeh G, Khalaf K, (click to view)

Jazaeri SZ, Azad A, Mehdizadeh H, Habibi SA, Mandehgary Najafabadi M, Saberi ZS, Rahimzadegan H, Moradi S, Behzadipour S, Parnianpour M, Taghizadeh G, Khalaf K,

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PloS one 2018 02 0113(2) e0192168 doi 10.1371/journal.pone.0192168
Abstract
BACKGROUND
Although anxiety is a common non-motor outcome of Parkinson’s disease (PD) affecting 40% of patients, little attention has been paid so far to its effects on balance impairment and postural control. Improvement of postural control through focusing on the environment (i.e. external focus) has been reported, but the role of anxiety, as a confounding variable, remains unclear.

OBJECTIVES
This study aimed to investigate the influence of anxiety and attentional focus instruction on the standing postural control of PD patients.

METHODS
Thirty-four patients with PD (17 with high anxiety (HA-PD) and 17 with low anxiety (LA-PD)), as well as 17 gender- and age-matched healthy control subjects (HC) participated in the study. Postural control was evaluated using a combination of two levels of postural difficulty (standing on a rigid force plate surface with open eyes (RO) and standing on a foam surface with open eyes (FO)), as well as three attentional focus instructions (internal, external and no focus).

RESULTS
Only the HA-PD group demonstrated significant postural control impairment as compared to the control, as indicated by significantly greater postural sway measures. Moreover, external focus significantly reduced postural sway in all participants especially during the FO condition.

CONCLUSION
The results of the current study provide evidence that anxiety influences balance control and postural stability in patients with PD, particularly those with high levels of anxiety. The results also confirmed that external focus is a potential strategy that significantly improves the postural control of these patients. Further investigation of clinical applicability is warranted towards developing effective therapeutic and rehabilitative treatment plans.

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