Concerns About Falling in Parkinson’s Disease: Associations with Disabilities and Personal and Environmental Factors

Abstract

Abstract.Background: Fear of falling can be conceptualized in different ways, e.g., as concerns about falling or low fall-related selfefficacy. It is common in people with Parkinson's disease (PD), and there is growing knowledge about its contributing factors. However, previous multivariate studies have mainly focused on fear of falling in relation to PD-related disabilities, and less is known about the associations between fear of falling and personal and environmental factors. Objective: To identify explanatory factors of concerns about falling in people with PD by focusing on personal and environmental factors as well as PD-related disabilities. Methods: Data were collected from 241 persons with PD (39% women, median age 70 years, PD duration 8 years). Concerns about falling (assessed with the Falls Efficacy Scale-International, FES-I; categorized into low, moderate, or high concerns) were used as the dependent variable in a multivariate ordinal regression analysis. Personal factors, environmental factors and PD-related disabilities constituted independent variables. Results: Low, moderate and high concerns about falling were reported by 29%, 24% and 47% of the participants, respectively. Walking difficulties, orthostatism, motor symptoms, age, and fatigue (presented in order of importance) were significant (p < 0.05) explanatory factors of concerns about falling. Conclusions: Several factors significantly explained concerns about falling in people with PD. Walking difficulties was by far the strongest explanatory factor. This suggests that minimizing walking difficulties should be a primary target when aiming at reducing concerns about falling in people with PD.

Factors Contributing to Perceived Walking Difficulties in People with Parkinson’s Disease

“…Based on data from the larger project [26] that this study is part of, general selfefficacy has been shown to independently contribute to life satisfaction [ 43], but not to concerns about falling [44] in people with PD. Other PD-studies have reported that selfefficacy is of importance for engagement in exercise [45] and self-management [46].…”

Determinants of Falls and Fear of Falling in Ambulatory Persons With Late Effects of Polio

“…As this is the first study to use multivariable analyses to investigate determinants of FOF in persons with late effects of polio, our results are difficult to compare with others. However, in persons with other neurologic diseases, such as stroke and Parkinson disease, decreased balance [33], muscle weakness in the lower limbs [27], and walking limitations [24,34] have been shown to be associated with FOF.…”

“…The score for each item is summarized, yielding a total score of 16‐64 points; a greater score indicates that the person is more concerned about falling. The FES‐I score also can be categorized as low FOF (16‐19 points), moderate FOF (20‐27 points), or high FOF (28‐64 points) [23,24]. The FES‐I has shown good psychometric properties [25] and is used commonly in persons with different neurologic and neuromuscular diseases [10,14,15,24,26,27].…”

Predictive Factors of Concerns about Falling in People with Parkinson’s Disease: A 3-Year Longitudinal Study

“…In order to be able to design efficient interventions for FOF in people with PD, it is important to gain an increased understanding of predictive factors of FOF. Seven previous cross-sectional studies used multivariable analyses in order to identify factors associated with FOF in people with PD [8,10,[19][20][21][22][23]. Four out of the seven studies addressed fallrelated self-efficacy [8,10,20,21].…”