title: Disability is an Independent Predictor of Falls and Recurrent Falls in People with Parkinson's Disease Without a History of Falls: A One-Year Prospective Study.
abstract: BACKGROUND
  Predictors of falls in people with Parkinson's disease (PD) who have not previously fallen are yet to be identified.
  
  
  OBJECTIVE
  We aimed to identify predictors of all falls and recurrent falls in people with PD who had not fallen in the previous year and to explore the timing of falls in a 12-month follow-up period.
  
  
  METHODS
  Participants with PD (n = 130) were assessed by disease-specific, self-report and balance measures. Falls were recorded prospectively for 12 months. Univariate and multivariate analyses were performed. Kaplan-Meier survival analysis was used to investigate time to falling.
  
  
  RESULTS
  Forty participants (31%) had ≥1 fall during follow-up and 21 (16%) had ≥2 falls. Disability, reduced balance confidence and greater concern about falling were associated with ≥1 fall in univariate analyses. Additionally, PD duration and severity, freezing of gait and impaired balance were associated with ≥2 falls (p <  0.05). Disability (Schwab and England scale, Odds Ratio [OR] = 0.56 per 10 points increase; 95% confidence interval [CI] 0.39-0.80; p = 0.002) was associated with ≥1 fall in the final multivariate model (area under the receiver operating characteristic curve [AUC] = 0.65; 95% CI 0.55-0.76; p = 0.005). Disability (Unified Parkinson's Disease Rating Scale activities of daily living, OR = 1.20; 95% CI 1.07-1.34; p = 0.001) and levodopa equivalent dose (OR = 1.11 per 100 mg increase; 95% CI 0.95-1.30; p = 0.19) were associated with ≥2 falls in the final multivariate model (AUC = 0.72; 95% CI 0.60-0.84; p = 0.001). Recurrent fallers experienced their first fall earlier than single fallers (p <  0.05).
  
  
  CONCLUSIONS
  Self-reported disability was the strongest single predictor of all falls and recurrent falls.
authors.affiliation: Movement Disorders and Parkinson's Disease Clinic, Roberto Santos General Hospital, Salvador, BA, Brazil.|Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, BA, Brazil.|Clinical and Rehabilitation Sciences Research Group, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia.
authors.forename: Lorena R S
authors.initials: LR
authors.lastname: Almeida
authors.affiliation: The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Catherine
authors.initials: C
authors.lastname: Sherrington
authors.affiliation: Clinical and Rehabilitation Sciences Research Group, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia.
authors.forename: Natalie E
authors.initials: NE
authors.lastname: Allen
authors.affiliation: The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Serene S
authors.initials: SS
authors.lastname: Paul
authors.affiliation: Movement Disorders and Parkinson's Disease Clinic, Roberto Santos General Hospital, Salvador, BA, Brazil.
authors.forename: Guilherme T
authors.initials: GT
authors.lastname: Valenca
authors.affiliation: Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, BA, Brazil.
authors.forename: Jamary
authors.initials: J
authors.lastname: Oliveira-Filho
authors.affiliation: Clinical and Rehabilitation Sciences Research Group, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia.
authors.forename: Colleen G
authors.initials: CG
authors.lastname: Canning
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000203:Activities of Daily Living; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D020233:Gait Disorders, Neurologic / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications / Q000453:epidemiology*; D004856:Postural Balance; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis
keywords: Parkinson’s disease; accidental falls; postural balance; risk factors