Everyday walking with Parkinson's disease: Understanding personal challenges and strategies

Purpose. This qualitative study was designed to explore the personal experience of everyday walking with Parkinson's disease (PD), the challenges and the strategies employed to compensate for difficulties, to help contextualise the scientific knowledge base. Methods. Semi-structured interviews were undertaken with a sample of 20 people with idiopathic PD (12 male, 8 female; mean age 65 years (range 50 – 80); mean disease duration 10 years (range 2.5 – 26). Verbatim interview transcripts were analyzed thematically using NUD*IST N6 qualitative data analysis software. Results. Walking was invariably performed as an integral part of a purposeful activity within a specific context, termed walking ‘plus’, with challenges encountered by people with PD in three main areas: Undertaking tasks; negotiating environments; and making transitions to walking. The two key strategies to compensate for difficulties experienced were monitoring through the use of concentration, and correcting through generating rhythm and size of steps. Carers supported monitoring and correcting. Conclusion. People with PD need to constantly assess and drive their walking performance. Attentional resources, which can themselves be compromised in PD, were used to accomplish what is normally a largely automatic activity. Personal accounts support scientific hypotheses. Rehabilitation interventions and measurements in PD need to reflect both the physical and psychosocial context of everyday walking.