Predicting Fallers in a Community-Based Sample of People with Parkinson’s Disease

Abstract

Background: The risk of people with Parkinson’s disease (PD) falling is greater than that of the general population but to date, disease-specific predictors of falling have not been identified. Objectives: To identify one or more features, which would predict individuals at risk of falling during a 3-month prospective follow-up study. Method: A battery of standardised tests administered in the home and the laboratory with a 3-month follow-up telephone interview. Results: Sixty-three people with PD were recruited from GP practices. Eleven interview variables and six gait laboratory variables were used with subsamples (55 and 44 subjects, respectively) to fit predictive models for identifying future fallers. The number of falls in the previous year was the most important variable, without exception, to be selected as a predictor in various logistic regression models. A history of two or more falls had a sensitivity of 86.4% (95% CI 67.3–96.2%) and a specificity of 85.7% (95% CI 71.2–94.2%) in predicting falling in the next 3 months. Conclusion: Healthcare workers should be asking their patients with PD regularly and carefully about falling, and should consider instigating programmes of fall management for patients with PD who have fallen two or more times in the previous 12 months.

Practice Parameter: Assessing patients in a neurology practice for risk of falls (an evidence-based review)

“…These found relative risks (RRs) of 2.4 (95% CI 1.9 to 2.9), 9 2.6 (no CI given), 10 and 2.5 (1.9 to 3.4) 6 and ORs of 3.7 (1.3 to 10.0) 11 and 2.4 (1.3 to 4.4). 12 Among 10 Class II studies, ORs were 3.0 (1.3 to 7.3), 13 16.0 (4.4 to 58.0), 14 5.0 (1.2 to 20.9), 15 2.0 (1.2 to 3.5), 16 3.5 (1.2 to 9.6), 17 2.4 (1.3 to 4.4), 12 5.4 (1.8 to 15.7), 18 3.1 (2.2 to 4.4), 19 12.5 (3.0 to 52.2), 20 and 4.0 (1.3 to 12.1). 21 Other Class II follow-up studies reported RRs of 1.9 (1.3 to 2.9) and 1.8 (1.3 to 2.4), 22 and 2.0 (1.3 to 3.1).…”

Balance and Gait Rehabilitation in Patients with Parkinson’s Disease

“…It has been emphasized that the incidence of falls in PD is high. In the past few years, six prospective studies have examined fall rates and consequently falls among communitydwelling patients with PD living in Canada, Netherlands, Australia and United Kingdom (Ashburn et al, 2001;Bloem et al, 2001;Bloem & Bathia, 2004;Hely et al, 1999;Temlett & Thompson, 2006;Morris, 2000). All these studies included patients suffering from Idiopathic PD who were able to walk and had no other causes for falls.…”

COMPARISON OF MINI-BESTest VERSUS BERG BALANCE SCALE TO EVALUATE BALANCE DISORDERS IN PARKINSON'S DISEASE.

“…[8][9][10][11][12] Many of these measures have limitations exist including low sensitivity and/or specificity 8,13 ceiling effects 16,15 and inclusion of items that physical therapy intervention cannot address (such as prior number of falls). 11,16,17 Some research has shown that a battery of tests is necessary to fully assess balance, however, a consensus on which tests to include and interpretation of results from multiple tests has not been reached. 9,13,18 To evaluate postural stability in a more functional context, these clinical scales would appear to be more appropriate than simple tests of postural stability.…”