title: Can postural instability tests improve the prediction of future falls in people with Parkinson's disease beyond knowing existing fall history?
abstract: This study sought to determine whether the backward-stepping Push and Release (P&R) Test and the Pull Test, or comprehensive batteries of postural instability (the Mini-BESTest and Brief-BESTest), significantly improve the prediction of future falls beyond knowing a person's baseline fall history. Complete data were available for 43 of 80 participants with PD. At baseline, participants completed the BESTest (which was scored for all versions and includes the P&R Test), the Unified PD Rating Scale (UPDRS) motor section (which includes the Pull Test), and the participants' reported falls experienced in the previous 6 months. Participants were classified as recurrent fallers if they reported more than one fall in the 12 months subsequent to baseline. Stepwise logistic regressions determined whether the P&R Test, Pull Test, Brief-BESTest, Mini-BESTest, or UPDRS motor score improved predictions of recurrent fallers independent of baseline fall-group status. Independently, all assessments significantly predicted future recurrent fallers, but only the Mini-BESTest and Brief-BESTest significantly improved predictions of future recurrent fallers independent of baseline fall-group status. The results suggest that, although single tests of reactive postural control do not offer significant predictive benefit, predictions of future recurrent fallers with PD do benefit from a balance examination in addition to knowing whether an individual has a recent history of falls.
authors.affiliation: Liberty Mutual Research Institute for Safety, 71 Frankland Rd, Hopkinton, MA, 01748, USA. jesse.jacobs@libertymutual.com.|Department of Rehabilitation and Movement Science, University of Vermont, 305 Rowell Building, 106 Carrigan Drive, Burlington, VT, 05405, USA. jesse.jacobs@libertymutual.com.
authors.forename: Jesse V
authors.initials: JV
authors.lastname: Jacobs
authors.affiliation: Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO, 63110, USA.|Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO, 63110, USA.|Department of Anatomy and Neurobiology, Washington University School of Medicine in St. Louis, St. Louis, MO, 63110, USA.
authors.forename: Gammon M
authors.initials: GM
authors.lastname: Earhart
authors.affiliation: Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO, 63110, USA.|Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO, 63110, USA.
authors.forename: Marie E
authors.initials: ME
authors.lastname: McNeely
mesh_terms: D000058:Accidental Falls; D000368:Aged; D005080:Exercise Test / Q000379:methods* / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000175:diagnosis* / Q000503:physiopathology; D004856:Postural Balance / Q000502:physiology*; D011379:Prognosis
keywords: BESTest; Falls; Parkinson’s disease; Pull Test; Push and Release Test