Rapid assessment of postural instability in Parkinson's disease (RAPID): a pilot study.
BACKGROUND
The Fahn's pull (or retropulsion) test is an item in the motor section of the Unified Parkinson's Disease Rating Scale, which is used almost exclusively to classify postural instability in Parkinson's disease (PD). However, the test is hard to standardize and is often performed incorrectly, making it hard to interpret. Moreover, it may not be safe to administer in patients who experience pain in the shoulders, neck, trunk and/or lower extremities. Identifying and grading postural instability in PD without requiring a physical challenge would not only be useful for the clinician but would assist patients and caregivers in its recognition. We propose the use of the rapid assessment of postural instability in Parkinson's disease (RAPID) questionnaire as a non-physical assessment tool.


METHODS
We determined the associations between the pull test and items on a risk-assessment questionnaire that consisted of three parts: activities of daily living, fear of falling, and frequency of falling.


RESULTS
Significant correlations were found between the pull test and the predictor variables, which ranged between 0.51 and 0.56 whilst the correlations amongst the predictor variables ranged between 0.58 and 0.70. The three parts of the questionnaire, when used in combination, produced a 96% sensitivity in the classification of postural instability.


CONCLUSIONS
The RAPID questionnaire can be used as an adjunct to the pull test or solely if the pull test is contraindicated. It may also be possible to administer the questionnaire via the telephone or Internet. It is hoped that the rapid identification of postural instability would lead to fewer falls.
Chong
R K Y
RKY
Department of Physical Therapy, Medical College of Georgia, Augusta, GA.
Morgan
J
J
Department of Neurology, Medical College of Georgia, Augusta, GA.
Mehta
S H
SH
Department of Neurology, Medical College of Georgia, Augusta, GA.
Pawlikowska
I
I
Department of Biostatistics, Medical College of Georgia, Augusta, GA, USA.
Hall
P
P
Department of Biostatistics, Medical College of Georgia, Augusta, GA, USA.
Ellis
A V
AV
Department of Physical Therapy, Medical College of Georgia, Augusta, GA.
Ibanez-Wong
A D
AD
Department of Physical Therapy, Medical College of Georgia, Augusta, GA.
Miller
G M
GM
Department of Physical Therapy, Medical College of Georgia, Augusta, GA.
Baugh
K
K
Department of Physical Therapy, Medical College of Georgia, Augusta, GA.
Sethi
K
K
Department of Neurology, Medical College of Georgia, Augusta, GA.
D019540:Area Under Curve; D006801:Humans; D010300:Parkinson Disease / Q000150:complications*; D010865:Pilot Projects; D004856:Postural Balance; D012372:ROC Curve; D012678:Sensation Disorders / Q000175:diagnosis* / Q000209:etiology; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D013997:Time Factors