Incidence and prediction of falls in Parkinson's disease: a prospective multidisciplinary study

Wood, Brian; Bilclough, J A; Bowron, A; Walker, Richard

doi:10.1136/jnnp.72.6.721

Cited by 584 publications

(503 citation statements)

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“…It is also common knowledge that the main symptoms of PD (rigidity, bradykinesia and tremors) may hamper the daily living activities right from the outset of the disease. In the course of its progression, changes in posture may arise, leading to postural instability, gait disturbance and a predisposition to falls [5][6][7] . As the ability to keep balance deteriorates, PD patients are susceptible to falls, which in turn commonly causes them to develop a fear of falling 7 .…”

Section: Discussionmentioning

confidence: 99%

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Impact of changes in balance and walking capacity on the quality of life in patients with Parkinson's disease

Scalzo

Flores

Marques

et al. 2012

Arq. Neuro-Psiquiatr.

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Parkinson' s disease (PD) is the second most common neurodegenerative disorder and it affects 0.3% of the population at large 1 . Pathologically, PD is characterized by the loss of the dopaminergic neurons from the substantia nigra pars compacta, causing the reduction of the striatal dopamine levels 2 . Clinically, PD is marked by the presence of tremors at rest, rigidity and bradykinesia 2 . With the PD progression, other impairments occur, such as postural instability 3 and gait dysfunctions 4 . These impairments result in a greater propensity to falls [5][6][7] , as well as a reduced capacity to walk 8 , and lead to progressive functional restraints. These physical aspects contribute to worsen the quality of life (QoL) in patients with PD 9-13 .QoL is a multidimensional concept that refers to an individual' s subjective perception concerning their life and other aspects, such as familial relationships, the patient' s own health, financial issues, housing, social life and leisure ABSTRACTParkinson's disease (PD) is characterized by motor symptoms that cause the decline of functional capacity and affect the quality of life (QoL). Objective: To evaluate the impact of changes in balance and walking capacity on the PD. Methods: The instruments used were: Unified Parkinson's Disease Rating Scale (UPDRS), modified Hoehn and Yahr Scale (HY), Schwab and England scale (SE), quality of life questionnaire (PDQ-39), Berg balance Scale (BBS) and six-minute walk test (6MWT). Results: Thirty-six patients with mean disease duration of 7.3 years were assessed. Lower scores on the BBS and shorter distances walked during the 6MWT correlated with a poorer perception of QoL. This correlation occurred at the expense of the mobility and daily living activities domains. Conclusion: Our results indicated that the impairment in balance while performing functional activities and the reduction in walking capacity are important factors that negatively affect the perception of QoL in PD patients.Key words: Parkinson's disease, quality of life, postural balance. RESUMOA doença de Parkinson (DP) é caracterizada por sintomas motores que causam declínio da capacidade funcional e afetam a qualidade de vida (QV). Objetivo: Avaliar o impacto das mudanças no equilíbrio e na capacidade de marcha em doentes com DP. Métodos: Foram utilizados instrumentos específicos para avaliação clínica da DP: Escala Unificada de Avaliação da Doença de Parkinson (UPDRS), Escala de Hoehn e Yahr (HY) modificada, Escala de Schwab e England (SE), questionário de qualidade de vida (PDQ-39), Escala de Equilíbrio de Berg (EEB) e teste de caminhada de seis minutos (TC6M). Resultados: Foram avaliados 36 pacientes, com duração média da doença de 7,3 anos. Menores pontuações na EEB e menores distâncias percorridas durante o TC6M mostraram correlação com pior percepção da QV. Essa correlação ocorreu em detrimento dos domínios de mobilidade e atividades de vida diária. Conclusão: Nossos resultados indicaram que o prejuízo no equilíbrio durante a realização de atividades funcio...

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Section: Discussionmentioning

confidence: 99%

“…With the PD progression, other impairments occur, such as postural instability 3 and gait dysfunctions 4 . These impairments result in a greater propensity to falls [5][6][7] , as well as a reduced capacity to walk 8 , and lead to progressive functional restraints. These physical aspects contribute to worsen the quality of life (QoL) in patients with PD 9-13 .…”

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confidence: 99%

Impact of changes in balance and walking capacity on the quality of life in patients with Parkinson's disease

Scalzo

Flores

Marques

et al. 2012

Arq. Neuro-Psiquiatr.

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“…As PD progresses, significant changes in posture and predisposition to fall may develop. This predisposition to fall may induce psychological reactions characterized by fear of future falling 5,22 . This fear of falling can be maladaptive when it compels patients to restrict their mobility, independence and social participation, leading to further limitation and gradual physical disability.…”

Section: Discussionmentioning

confidence: 99%

Validation of the brazilian version of the berg balance scale for patients with parkinson's disease

Scalzo

Nova

Perracini

et al. 2009

Arq. Neuro-Psiquiatr.

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-Background: Changes in balance occur with the progression of Parkinson's disease (PD). Objective: To validate the Brazilian version of the Berg Balance Scale (BBS) for PD patients, determining its reliability and internal consistency and correlating it with PD-specific instruments. Method: We evaluated 53 patients (M/F 37/16, mean age±SD, 62±7.9 years) with PD (mean±SD, 7.8±4.4 years). Unified Parkinson's Disease Rating Scale (UPDRS), Schwab and England Scale (S&E), Hoehn and Yahr Staging Scale (HY) and BBS were used to assess patients. Statistical analyses for inter-rater reliability, internal consistency and correlations among BBS, UPDRS, S&E and HY were performed. Results: The mean scores±SD on UPDRS and BBS were, respectively, 41.6±17.8 and 47.2±8.2. The median on S&E and HY scales were 80% and 2.5, respectively. The BBS presented a high intraclass correlation coefficient (ICC=0.84) and internal consistency (Cronbrach's α=0.92). There was a statistically significant correlation between BBS and disease duration (r s = -0.520, p<0.001), UPDRS subscales II and III (r s = -0.467, p=0.011; r s = -0.374, p=0.046, respectively), stage of disease (HY; r s = -0.507, p<0.001) and the activities of daily living (S&E; r s =0.492, p<0.001). Conclusion: The BBS is a promising tool for the assessment of balance in PD, correlating with the stage of disease and the level of independence.KEY WORDS: Parkinson's disease, postural instability, Berg Balance Scale. Validação da versão brasileira da Escala de Equilíbrio de Berg para pacientes com a doença de ParkinsonResumo -Alterações de equilíbrio ocorrem com a progressão da doença de Parkinson (DP). Objetivo: Validar a versão brasileira da Escala de Equilíbrio de Berg (EEB) para pacientes com DP, determinando a confiabilidade, a consistência interna e correlacionando com instrumentos específicos da DP. Método: Foram avaliados 53 pacientes (H/M 37/16, idade média±DP, 62±7,9 anos) com DP (media±DP, 7,8±4,4 anos). Escala de Graduação Unificada da Doença de Parkinson (UPDRS), Escala de Schwab e England (S&E), Escala de Estágios de Hoehn e Yahr (HY) e EEB foram utilizadas. Análise estatística para confiabilidade entre examinadores, consistência interna e correlações entre EEB, UPDRS, S&E e HY foram realizadas. Resultados: Os escores médios±DP nas escalas UPDRS e EEB foram, respectivamente, 41,6±17,8 e 47,2±8,2. A mediana nas escalas S&E e HY foram 80% e 2,5. A EEB mostrou ter alto coeficiente de correlação intraclasse (ICC=0,84) e consistência interna (α de Cronbach=0,92). Houve correlação estatisticamente significativa entre EEB e a duração da doença (r s = -0,520, p<0,001), subescalas II e III do UPDRS (r s = -0,467, p=0,011; r s = -0,374, p=0,046, respectivamente), estágio da doença (HY; r s = -0,507, p<0,001), com as atividades da vida diária (S&E; r s = 0,492; p<0,001). Conclusão: A EEB é um instrumento promissor para avaliar o equilíbrio na DP, correlacionando-se com o estágio da doença e o nível de independência.

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“…2,5 The incidence is clearly higher than that reported in the elderly (33%) 6,7 and patients with other neurological disorders such as stroke (37-73%) 8,9 and Parkinson's diseases (51-68%). 10,11 After falls, 18% of subjects with SCI reported fracture and 45% had restricted ability to get out into communities and engage in a productive activity. 2 Amatachaya et al 5 also found that, among 17 faller subjects, seven of them had bruises, one reported muscular pain and one experienced metatarsal bone fracture that required medical attention and readmission with limitation of weight bearing for 14 days.…”

Section: Introductionmentioning

confidence: 99%

Falls in independent ambulatory patients with spinal cord injury: incidence, associated factors and levels of ability

2012

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Study Design: A 6-month retrospective study. Objectives: To investigate incidence and factors associated with falls in independent ambulatory patients with spinal cord injury (SCI), and to compare levels of ability in those with and without a history of falls. Setting: A tertiary rehabilitation center and community hospitals. Methods:Seventy-seven independent ambulatory subjects with SCI were interviewed for fall data during 6 months before participation in the study. Subjects were also assessed for their functional ability using the timed up and go test (TUGT) and the 6-min walk test (6MinWT). Results: Twenty-six subjects (34%) reported falls during 6 months (range 1-6 times). After falls, two subjects required medical attention due to wrist joint fracture and back pain. Walking without a walking device significantly increased the risk of fall, whereas using a walker significantly reduced the risk of fall (Po0.05). Moreover, faller subjects showed significantly better levels of ability than the non-faller subjects (Po0.005 for the TUGT and Po0.05 for the 6MinWT).Conclusion: Approximately one-third of the independent ambulatory subjects with SCI experienced falls. Notably, faller subjects had better functional ability than the non-faller subjects. Thus, apart from emphasizing the ability to walk independently, rehabilitation professionals may need to seek strategies that improve balance and safety.

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Incidence and prediction of falls in Parkinson's disease: a prospective multidisciplinary study

Cited by 584 publications

References 40 publications

Impact of changes in balance and walking capacity on the quality of life in patients with Parkinson's disease

Impact of changes in balance and walking capacity on the quality of life in patients with Parkinson's disease

Validation of the brazilian version of the berg balance scale for patients with parkinson's disease

Falls in independent ambulatory patients with spinal cord injury: incidence, associated factors and levels of ability

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