Clinical tests for the evaluation of postural instability in patients with parkinson's disease.
OBJECTIVE
To determine which test for postural instability in Parkinson's disease (PD) is reliable, valid, and easy to perform in a clinical setting.


METHODS
Cross-sectional reliability and validity study.


METHODS
Academic center for movement disorders.


METHODS
Forty-two patients with PD and 15 controls. Based on the results of a structured interview, the patients were divided in PD-unstable (n=22) and PD-stable (n=20) groups.


METHODS
Not applicable.


METHODS
Several variants of the retropulsion test with differences in execution and scoring. Responses were scored on 5 different rating scales (ratings of Nutt, Bloem, Pastor; the Unified Parkinson's Disease Rating Scale [UPDRS]; the Short Parkinson Evaluation Scale). These tests were compared with steady-stance positions.


RESULTS
The interrater reliability was high for most ratings, with weighted kappa ranging from.63 for the UPDRS to.98 for both the Pastor rating and steady-stance positions. Most ratings distinguished between the groups. However, the Nutt rating had the highest overall predictive accuracy, with a sensitivity of.63 and a specificity of.88.


CONCLUSIONS
The most valid test for postural stability in PD was an unexpected shoulder pull, executed once, with taking more than 2 steps backward considered abnormal. This retropulsion test is easy to use in a clinical setting.
Visser
Martine
M
Departmentof Neurology, Leiden University Medical Center, The Netherlands. m.visser@lumc.nl
Marinus
Johan
J
Bloem
Bastiaan R
BR
Kisjes
Hannah
H
van den Berg
Barbara M
BM
van Hilten
Jacobus J
JJ
D000058:Accidental Falls / Q000706:statistics & numerical data; D000368:Aged; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000145:classification* / Q000503:physiopathology / Q000534:rehabilitation; D004856:Postural Balance; D011187:Posture; D015203:Reproducibility of Results