title: Three simple clinical tests to accurately predict falls in people with Parkinson's disease.
abstract: Falls are a major cause of morbidity in Parkinson's disease (PD). The objective of this study was to identify predictors of falls in PD and develop a simple prediction tool that would be useful in routine patient care. Potential predictor variables (falls history, disease severity, cognition, leg muscle strength, balance, mobility, freezing of gait [FOG], and fear of falling) were collected for 205 community-dwelling people with PD. Falls were monitored prospectively for 6 months using monthly falls diaries. In total, 125 participants (59%) fell during follow-up. A model that included a history of falls, FOG, impaired postural sway, gait speed, sit-to-stand, standing balance with narrow base of support, and coordinated stability had high discrimination in identifying fallers (area under the receiver-operating characteristic curve [AUC], 0.83; 95% confidence interval [CI], 0.77-0.88). A clinical tool that incorporated 3 predictors easily determined in a clinical setting (falling in the previous year: odds ratio [OR], 5.80; 95% CI, 3.00-11.22; FOG in the past month: OR, 2.39; 95% CI, 1.19-4.80; and self-selected gait speed < 1.1 meters per second: OR, 1.86; 95% CI, 0.96-3.58) had similar discrimination (AUC, 0.80; 95% CI, 0.73-0.86) to the more complex model (P = 0.14 for comparison of AUCs). The absolute probability of falling in the next 6 months for people with low, medium, and high risk using the simple, 3-test tool was 17%, 51%, and 85%, respectively. In people who have PD without significant cognitive impairment, falls can be predicted with a high degree of accuracy using a simple, 3-test clinical tool. This tool enables individualized quantification of the risk of falling. © 2013 Movement Disorder Society.
authors: Clinical and Rehabilitation Sciences Research Group, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia. serene.paul@sydney.edu.au
authors: Serene S
authors: SS
authors: Paul
authors: Colleen G
authors: CG
authors: Canning
authors: Catherine
authors: C
authors: Sherrington
authors: Stephen R
authors: SR
authors: Lord
authors: Jacqueline C T
authors: JC
authors: Close
authors: Victor S C
authors: VS
authors: Fung
mesh_terms: D000058:Accidental Falls; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010300:Parkinson Disease / Q000150:complications*; D004856:Postural Balance / Q000502:physiology*; D011237:Predictive Value of Tests; D011336:Probability; D012372:ROC Curve; D012678:Sensation Disorders / Q000175:diagnosis* / Q000209:etiology*; D012720:Severity of Illness Index