Understanding Cueing Strategies for Gait Impairments in Parkinson's Disease: Protocol of the Multicenter UNITE‐PD Study

Gait impairments impact independence and quality of life of persons with Parkinson's disease (PD). The application of external and internal cueing strategies can improve gait, but not every person benefits equally from the same strategy. It remains unclear (i) which patient characteristics mediate cueing efficacy, (ii) how cueing efficacy changes over time, (iii) which patient characteristics are associated with long-term compliance, and (iv) what the neural correlates of cueing are. The UNITE-PD study is a collaboration between the Radboud University Medical Center (NLD), KU Leuven (BEL), Tel Aviv Sourasky Medical Center (ISR), and IRCCS Policlinico San Martino (ITA). The study consists of a joint prospective cohort project and four site-specific projects. We here describe the joint project, with the site-specific projects included as supplementary materials. All participants undergo a baseline assessment, consisting of extensive clinical testing and an objective gait assessment with and without external and internal cueing. Responders and non-responders to the strategy will be followed for 6 months. Responders will be instructed to apply the effective cueing strategies, as much as possible in daily life using a mobile cueing application which tracks compliance. At 6 months post-baseline, responders and non-responders return to the lab, during which the baseline protocol will be repeated to quantify the change in efficacy of the cueing strategies over time. The UNITE-PD study will identify the relationship between patient characteristics, cueing efficacy, compliance, and the underlying mechanisms of cueing. This knowledge will help refine personalized rehabilitation and identify new avenues for neuroscientific inquiry in this domain.