Effect of Fear of Falling on Mobility Measured During Lab and Daily Activity Assessments in Parkinson’s Disease

Abstract

In chronic disorders such as Parkinson’s disease (PD), fear of falling (FOF) is associated with falls and reduced quality of life. With inertial measurement units (IMUs) and dedicated algorithms, different aspects of mobility can be obtained during supervised tests in the lab and also during daily activities. To our best knowledge, the effect of FOF on mobility has not been investigated in both of these settings simultaneously. Our goal was to evaluate the effect of FOF on the mobility of 26 patients with PD during clinical assessments and 14 days of daily activity monitoring. Parameters related to gait, sit-to-stand transitions, and turns were extracted from IMU signals on the lower back. Fear of falling was assessed using the Falls Efficacy Scale-International (FES-I) and the patients were grouped as with (PD-FOF+) and without FOF (PD-FOF−). Mobility parameters between groups were compared using logistic regression as well as the effect size values obtained using the Wilcoxon rank-sum test. The peak angular velocity of the turn-to-sit transition of the timed-up-and-go (TUG) test had the highest discriminative power between PD-FOF+ and PD-FOF− (r-value of effect size = 0.61). Moreover, PD-FOF+ had a tendency toward lower gait speed at home and a lower amount of walking bouts, especially for shorter walking bouts. The combination of lab and daily activity parameters reached a higher discriminative power [area under the curve (AUC) = 0.75] than each setting alone (AUC = 0.68 in the lab, AUC = 0.54 at home). Comparing the gait speed between the two assessments, the PD-FOF+ showed higher gait speeds in the capacity area compared with their TUG test in the lab. The mobility parameters extracted from both lab and home-based assessments contribute to the detection of FOF in PD. This study adds further evidence to the usefulness of mobility assessments that include different environments and assessment strategies. Although this study was limited in the sample size, it still provides a helpful method to consider the daily activity measurement of the patients with PD into clinical evaluation. The obtained results can help the clinicians with a more accurate prevention and treatment strategy.

Static Balance and Chair-Rise Performance in Neurogeriatric Patients: Promising Short Physical Performance Battery-Derived Predictors of Fear of Falling

“…In line with this observation, studies in PD patients found an association between self-rated walking disability and FOF, but not between gait speed and FOF ( 32 , 33 ). Additionally, a study in patients with PD found a significant difference in the time needed to perform the two turns during the Timed-up-go (TUG) including the stand-to-sit movement test between individuals with and without FOF, but not in the gait speed ( 38 ). Therefore, concerning FOF, this study also highlights the importance of the capability to perform transitions and does not see gait speed per se as relevantly predictive of this symptom.…”

“…Adding to the importance of balance with regard to FOF, an intervention study was able to show that balance training reduces FOF in older institutionalized patients (37). Evidence on the relationship between FOF and gait speed (which is represented by walking duration in the SPPB) differs in the literature (32,(38)(39)(40)(41). For example, a study in patients with PD found a correlation between FOF and gait speed in bivariate analysis, but not in multivariate regression analysis (32).…”

Gait Characteristics Associated with Fear of Falling in Hospitalized People with Parkinson’s Disease

“…FOF restricts mobility, social participation, and quality of life [ 5 , 6 ]. FOF predicts future falls and therefore is relevant to consider FOF for fall risk assessment [ 7 , 8 , 9 , 10 , 11 ].…”

Fear of Falling Does Not Influence Dual-Task Gait Costs in People with Parkinson’s Disease: A Cross-Sectional Study

“…Fear of falling (FOF) is a common and serious problem in patients with PD, which influences gait patterns [16,17]. FOF has been defined as ongoing concern about falling, low fall-related self-efficacy, and activity avoidance [18].…”