title: Balance differences in people with Parkinson disease with and without freezing of gait.
abstract: BACKGROUND
  Freezing of gait (FOG) is a relatively common and remarkably disabling impairment associated with Parkinson disease (PD). Laboratory-based measures indicate that individuals with FOG (PD+FOG) have greater balance deficits than those without FOG (PD-FOG). Whether such differences also can be detected using clinical balance tests has not been investigated. We sought to determine if balance and specific aspects of balance, measured using Balance Evaluation Systems Test (BESTest), differs between PD+FOG and PD-FOG. Furthermore, we aimed to determine if time-efficient clinical balance measures (i.e. Mini-BESTest, Berg Balance Scale (BBS)) could detect balance differences between PD+FOG and PD-FOG.
  
  
  METHODS
  Balance of 78 individuals with PD, grouped as either PD+FOG (n=32) or PD-FOG (n=46), was measured using the BESTest, Mini-BESTest, and BBS. Between-groups comparisons were conducted for these measures and for the six sections of the BESTest using analysis of covariance. A PD composite score was used as a covariate.
  
  
  RESULTS
  Controlling for motor sign severity, PD duration, and age, PD+FOG had worse balance than PD-FOG when measured using the BESTest (p=0.008, F=7.35) and Mini-BESTest (p=0.002, F=10.37), but not the BBS (p=0.27, F=1.26). BESTest section differences were noted between PD+FOG and PD-FOG for reactive postural responses (p<0.001, F=14.42) and stability in gait (p=0.003, F=9.18).
  
  
  CONCLUSIONS
  The BESTest and Mini-BESTest, which specifically assessed reactive postural responses and stability in gait, were more likely than the BBS to detect differences in balance between PD+FOG and PD-FOG. Because it is more time efficient to administer, the Mini-BESTest may be the preferred tool for assessing balance deficits associated with FOG.
authors.affiliation: Washington University School of Medicine in Saint Louis, Program in Physical Therapy, St. Louis, MO, United States; Washington University School of Medicine in Saint Louis, Department of Neurology, St. Louis, MO, United States.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Duncan
authors.affiliation: Rehabilitation Hospital of the Pacific, Department of Physical Therapy, Honolulu, HI, United States.
authors.forename: Abigail L
authors.initials: AL
authors.lastname: Leddy
authors.affiliation: University of New England, Department of Physical Therapy, Portland, ME, United States.
authors.forename: James T
authors.initials: JT
authors.lastname: Cavanaugh
authors.affiliation: University of Utah, Department of Physical Therapy, Salt Lake City, UT, United States.
authors.forename: Leland E
authors.initials: LE
authors.lastname: Dibble
authors.affiliation: Boston University, Department of Physical Therapy and Athletic Training, Boston, MA, United States.
authors.forename: Terry D
authors.initials: TD
authors.lastname: Ellis
authors.affiliation: Samford University, Department of Physical Therapy, Birmingham, AL, United States.
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Ford
authors.affiliation: University of Utah, Department of Physical Therapy, Salt Lake City, UT, United States.
authors.forename: K Bo
authors.initials: KB
authors.lastname: Foreman
authors.affiliation: Washington University School of Medicine in Saint Louis, Program in Physical Therapy, St. Louis, MO, United States; Washington University School of Medicine in Saint Louis, Department of Neurology, St. Louis, MO, United States; Washington University School of Medicine in Saint Louis, Department of Anatomy & Neurobiology, St. Louis, MO, United States. Electronic address: earhartg@wusm.wustl.edu.
authors.forename: Gammon M
authors.initials: GM
authors.lastname: Earhart
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D005684:Gait / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000503:physiopathology*; D004856:Postural Balance / Q000502:physiology*; D015203:Reproducibility of Results
keywords: BESTest; Balance; Freezing of gait; Mini-BESTest; Parkinson disease