title: The circumstances of falls among people with Parkinson's disease and the use of Falls Diaries to facilitate reporting.
abstract: OBJECTIVE
  Falls are common in Parkinson's disease (PD). Falls Diaries are one way of recording fall frequency and the surrounding circumstances; completing them encourages recall, and their content focuses intervention. We reviewed the diaries completed by people with PD during a randomized controlled trial (RCT) of fall prevention to ascertain the key circumstances surrounding falls.
  
  
  METHODS
  We asked independently mobile, cognitively intact people with a diagnosis of PD to maintain a Falls Diary throughout a six-month RCT. We sent monthly diary sheets on which to answer questions about the 'Location', 'Fall-related activity', 'Perceived cause', 'Landing' and 'Consequences' of every fall. We coded responses and counted frequencies.
  
  
  RESULTS
  Of the 142 RCT participants (mean age 72 years; mean years since diagnosis 8), 135 completed the trial and their diary. We excluded 11 (8%) for missing data and/or unintelligible writing. The 124 remaining diaries recorded 639 falls: 80% happened at home, commonly in bedrooms, living areas, kitchens and gardens. Fallers had been ambulant in 45% of events, standing in 32% and transferring in 21%. Six 'activity-cause combinations' accounted for 55% of falls (tripping 13%; freezing, festination and retropulsion 11%; and postural instability when bending or reaching 9%, transferring 8%, walking 7% and washing or dressing 7%). Misjudgement and distraction played a part in 12% of falls described.
  
  
  CONCLUSIONS
  Of over 600 falls surveyed, most happened at home, provoked by postural instability, tripping and freezing. Environmental adaptation and cognitive training should be trialled in falls prevention in PD, plus or minus traditional movement rehabilitation. Most participants completed Falls Diaries successfully. We advocate diary use, with follow-up interviews, in research and clinically. People with handwriting difficulty may require a typed diary, proxy diarist or interview.
authors.affiliation: School of Health Professions & Rehabilitation Science, University of Southampton, UK. ann@soton.ac.uk
authors.forename: A
authors.initials: A
authors.lastname: Ashburn
authors.forename: E
authors.initials: E
authors.lastname: Stack
authors.forename: C
authors.initials: C
authors.lastname: Ballinger
authors.forename: L
authors.initials: L
authors.lastname: Fazakarley
authors.forename: C
authors.initials: C
authors.lastname: Fitton
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000061:Accidents, Home / Q000706:statistics & numerical data*; D000203:Activities of Daily Living; D000368:Aged; D015331:Cohort Studies; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D008499:Medical Records; D010300:Parkinson Disease / Q000150:complications*; D016032:Randomized Controlled Trials as Topic