• Rimsha Fatima Student Physical Therapy Department Lahore College of Physical Therapy LM&DC Lahore
  • Nabeela Safdar Senior Lecturer Neurosciences, Department Lahore College of Physical Therapy, LM&DC Lahore
  • Somia Faisal Demonstrator Applied Science Department Lahore College of Physical Therapy, LM&DC Lahore
  • Hafiz Muhammad Asim Professor Lahore College of Physical Therapy, LM&DC Lahore Pakistan


Functional status, parkinson disease, cognitive dysfunction, disease progression, orthostatic hypotension, tremors


Aims Of Study: The purpose of the study was to assess the functional capabilities of patients with Stage III Parkinson's disease (PD). Functional status of PD patients declines due to impaired postural reflexes and characteristic loss of balance which became evident at Stage III thus activities of daily living (ADLs) are compromised as the severity of the disease increases.

Methodology:  Descriptive case series was conducted on stage III PD patients (n=64). Patients with age ranges from 45 to 75 years were recruited and patients with other neurological issues were excluded. They were assessed using a Functional independence measure scale having reliability 0.95.

Results: Out of 64 patients, 75% required minimal assistance and 9.4% required supervision while performing the ADLs. Whereas, 81% of patients need 2 hours of personal care assistance according to burden of care.

Limitations & Future Implications: Only functional status of PD patient is determined no exercise regime or intervention were incorporated to assess their impact on the PD patient functional activities. Thus, future studies should be carried out to find the correlation between aerobic exercises and their impact on PD patient level of functional independence.

Originality: Information added was all taken from databases and reduced to similarity index and was not submitted to any other journal.

Conclusion: Stage III Parkinson’s disease patient required minimal level of assistance while performing tasks of daily living. However, majority of these patients required 2 hours of personal care assistance on average per day to compete with daily living.

Author Biographies

Rimsha Fatima, Student Physical Therapy Department Lahore College of Physical Therapy LM&DC Lahore




Nabeela Safdar, Senior Lecturer Neurosciences, Department Lahore College of Physical Therapy, LM&DC Lahore



Somia Faisal, Demonstrator Applied Science Department Lahore College of Physical Therapy, LM&DC Lahore



Hafiz Muhammad Asim, Professor Lahore College of Physical Therapy, LM&DC Lahore Pakistan




Feng H, Li C, Liu J, Wang L, Ma J, Li G, Gan L, Shang X, Wu Z. Virtual reality rehabilitation versus conventional physical therapy for improving balance and gait in Parkinson’s disease patients: a randomized controlled trial. Medical science monitor: international medical journal of experimental and clinical research. 2019;25: pp 4186.

Abbas MM, Xu Z, Tan LC. Epidemiology of Parkinson's disease—East versus West. Movement disorders clinical practice. 2018 Jan;5(1): pp 14-28.

Minić I, Pejčić A, Popović S. Link between periodontal inflammatory disease and Parkinson’s disease. GSC Advanced Research and Reviews. 2020;5(2): pp 84-88.

Zhao P, Zhang B, Gao S, Li X. Clinical features, MRI, and 18F‐FDG‐PET in differential diagnosis of Parkinson disease from multiple system atrophy. Brain and Behavior. 2020 Nov;10(11): pp e01827.

Filippi M, Elisabetta S, Piramide N, Agosta F. Functional MRI in idiopathic Parkinson's disease. International review of neurobiology. 2018;141: pp 439-467.

Imtiaz N, Mehreen S, Saeed K, Akhtar N, Ur H, Rehman SA, Rehman AU, Ali J, Ayub M. Study of prevalence of Parkinson’s disease in elderly population in Rawalpindi, Pakistan. Pakistan. J. Entomol.Zool Stud. 2016; 4(6): pp 845-847.

Durcan R, Wiblin L, Lawson RA, Khoo TK, Yarnall AJ, Duncan GW, Brooks DJ, Pavese N, Burn DJ, ICICLE‐PD Study Group. Prevalence and duration of non‐motor symptoms in prodromal Parkinson's disease. European journal of neurology. 2019 Jul; 26(7): pp 979-985.

Cerri S, Mus L, Blandini F. Parkinson’s disease in women and men: What’s the difference? Journal of Parkinson's disease. 2019 Jan 1; 9(3): pp 501-515.

Tsiouris KM, Rigas G, Antonini A, Gatsios D, Konitsiotis S, Koutsouris DD, Fotiadis DI. Mining motor symptoms UPDRS data of Parkinson's disease patients for the development of Hoehn and Yahr estimation decision support system. In 2017 IEEE EMBS International Conference on Biomedical & Health Informatics (BHI) 2017 Feb 16: pp 445-448. IEEE.

Fine EM, Meier A, Serbin M, Stahl M, Dabbous F. Parkinson’s Disease Burden by Hoehn and Yahr Stage Using Real-World Data from the Parkinson’s Outcomes Project (4183) 2021.

Chatterjee N. Automatic Classification of Parkinson’s Disease Based on Severity Estimation. Proceedings of the 1st International Conference on Data Science, Machine Learning and Applications 2020 May 19; 601: pp 190.

Kahn L, Mathkour M, Lee SX, Gouveia EE, Hanna JA, Garces J, Scullen T, McCormack E, Riffle J, Glynn R, Houghton D. Long-term outcomes of deep brain stimulation in severe Parkinson’s disease utilizing UPDRS III and modified Hoehn and Yahr as a severity scale. Clinical neurology and neurosurgery. 2019 Apr 1; 179: pp 67-73.

Weil RS, Winston JS, Leyland LA, Pappa K, Mahmood RB, Morris HR, Rees G. Neural correlates of early cognitive dysfunction in Parkinson's disease. Annals of clinical and translational neurology. 2019 May; 6(5): pp 902-912.

Wang CY, Chan L, Wu D, Chi WC, Yen CF, Liao HF, Hong CT, Liou TH. Effect of cognitive disability and ambulation status on functioning in moderate-to-advanced Parkinson disease. Frontiers in Neurology. 2020 Jan 9; 10: pp 1360.

Mirelman A, Ben Or Frank M, Melamed M, Granovsky L, Nieuwboer A, Rochester L, Del Din S, Avanzino L, Pelosin E, Bloem BR, Della Croce U. Detecting Sensitive Mobility Features for Parkinson's Disease Stages Via Machine Learning. Movement Disorders. 2021 Sep; 36(9): pp 2144-2155.

Kanegusuku H, Ritti-Dias RM, Barbosa PY, das Neves Guelfi ET, Okamoto E, Miranda CS, de Paula Oliveira T, Piemonte ME. Influence of motor impairment on exercise capacity and quality of life in patients with Parkinson disease. Journal of Exercise Rehabilitation. 2021 Aug; 17(4): pp 241.

Palakurthi B, Burugupally SP. Postural instability in Parkinson’s disease: a review. Brain sciences. 2019 Sep 18;9(9): pp 239.

Kotagal V, Bohnen NI, Müller ML, Frey KA, Albin RL. Cerebral amyloid burden and Hoehn and Yahr stage 3 scoring in Parkinson's disease. Journal of Parkinson's disease. 2017;7(1): pp 143-147.

Santos P, Machado T, Santos L, Ribeiro N, Melo A. Efficacy of the Nintendo Wii combination with Conventional Exercises in the rehabilitation of individuals with Parkinson’s disease: A randomized clinical trial. NeuroRehabilitation. 2019 Jan 1; 45(2): pp 255-263.

Brosseau L, Wolfson C. The inter-rater reliability and construct validity of the Functional Independence Measure for multiple sclerosis subjects. Clinical Rehabilitation. 1994 May;8(2): pp 107-115.

Gkouma A, Theotokatos G, Geladas N, et al. Validity and Reliability Evidence of the Functional Independence Measurement (FIM) for individuals with Neurological Disorders in Greece. J Med - Clin Res & Rev. 2022; 6(5): pp 1-11.

Paul KC, Chuang YH, Shih IF, Keener A, Bordelon Y, Bronstein JM, et al. The association between lifestyle factors and Parkinson's disease progression and mortality. Movement Disorders. 2019;34(1): pp 58-66.

Macchi ZA, Koljack CE, Miyasaki JM, Katz M, Galifianakis N, Prizer LP, Sillau SH, Kluger BM. Patient and caregiver characteristics associated with caregiver burden in Parkinson’s disease: a palliative care approach. Ann Palliat Med. 2020 Feb 1; 9: pp 24-33.

Feigin VL, Nichols E, Alam T, Bannick MS, Beghi E, Blake N, et al. Global, regional, and national burden of neurological disorders, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Neurology. 2019;18(5): pp 459-480.

Pelicioni PH, Menant JC, Latt MD, Lord SR. Falls in Parkinson’s disease subtypes: risk factors, locations and circumstances. International journal of environmental research and public health. 2019;16(12): pp 2216.

Gupta DK, Fahn S, Tatsuoka C, Kang UJ. Hoehn and Yahr stage 3 and postural stability item in the movement disorder society–unified Parkinson's disease rating scale. Movement Disorders. 2018;33(7): pp 1188-1189.

Valach L, Selz B. Rehabilitation Programs monitored by Functional Independence Measure: An Observational Study. Int Phys Med Rehab J. 2017;2(1): pp 00039.

Kaseda Y, Ikeda J, Sugihara K, Yamawaki T, Kohriyama T, Matsumoto M. Therapeutic effects of intensive inpatient rehabilitation in advanced Parkinson's disease. Neurology and clinical neuroscience. 2017;5(1): pp 18-21.

Li Y, Song H, Shen L, Wang Y. The efficacy and safety of moderate aerobic exercise for patients with Parkinson’s disease: a systematic review and meta-analysis of randomized controlled trials. Ann Palliat Med. 2021 Mar 1;10(3): pp 2638-2649.




How to Cite

Fatima, R. ., Safdar, N., Faisal, S., & Asim, H. M. . (2023). FUNCTIONAL STATUS AMONG PATIENTS WITH STAGE III PARKINSON’S DISEASE. Pakistan Journal of Rehabilitation, 12(2), 52–59. Retrieved from

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