title: Comparison of Self-report and Performance-Based Balance Measures for Predicting Recurrent Falls in People With Parkinson Disease: Cohort Study.
abstract: BACKGROUND
  Balance confidence and fear of falling are factors associated with recurrent falls in people with Parkinson disease (PD). However, the accuracy for predicting falls on the basis of self-report measures has not been widely investigated.
  
  
  OBJECTIVE
  The study objectives were: (1) to compare the accuracy of the Activities-specific Balance Confidence Scale (ABC) and the Falls Efficacy Scale-International (FES-I) with that of the Berg Balance Scale (BBS), Dynamic Gait Index (DGI), Functional Reach Test (FRT), and Timed "Up & Go" Test (TUG) for predicting recurrent falls in people with PD and (2) to explore the ability of combinations of up to 3 tests to predict recurrent falls.
  
  
  METHODS
  This was a prospective cohort study involving 225 people with PD.
  
  
  METHODS
  Participants were assessed with the ABC, FES-I, BBS, FRT, TUG, and DGI. Participants who reported 2 or more falls in the 12-month follow-up period were classified as recurrent fallers. Areas under the receiver operating characteristic curves were determined, and the Akaike information criterion was used to select the best predictive model.
  
  
  RESULTS
  Eighty-four participants (37.3%) were classified as recurrent fallers. Areas under the receiver operating characteristic curves for the ABC, FES-I, TUG, FRT, DGI, and BBS were 0.73, 0.74, 0.72, 0.74, 0.76, and 0.79, respectively. Two-test models provided additional discriminating ability compared with individual measures and had Akaike information criterion values similar to those of 3-test models, particularly the combination of the BBS with the FES-I.
  
  
  CONCLUSIONS
  The lack of an external validation sample was a limitation of this study.
  
  
  CONCLUSIONS
  The ABC and FES-I demonstrated moderate accuracy in predicting recurrent falls and a predictive ability similar to that of performance-based balance measures, especially the FRT and the TUG. Two-test models showed performance similar to that of 3-test models, suggesting that a combination of 2 measures may improve the ability to predict recurrent falls in people with PD. Specifically, the combination of the BBS with the FES-I may be considered.
authors.affiliation: L.R.S. Almeida, PT, MSc, Movement Disorders and Parkinson's Disease Clinic, Roberto Santos General Hospital/SESAB, Rua Direta do Saboeiro, s/n-Cabula, 41180-780, Salvador, Bahia, Brazil; Postgraduate Program in Health Sciences, School of Medicine, Federal University of Bahia, Salvador, Bahia, Brazil; and Behavior and Motor Learning Research Group, Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil. lorenasantos@gmail.com.
authors.forename: Lorena R S
authors.initials: LR
authors.lastname: Almeida
authors.affiliation: G.T. Valenca, MD, PhD, Movement Disorders and Parkinson's Disease Clinic, Roberto Santos General Hospital/SESAB, and Health Sciences Center, Federal University of Reconcavo of Bahia, Santo Antônio de Jesus, Bahia, Brazil.
authors.forename: Guilherme T
authors.initials: GT
authors.lastname: Valenca
authors.affiliation: N.N. Negreiros, RN, Movement Disorders Clinic, State of Bahia Health Attention Center for the Elderly/SESAB, Salvador, Bahia, Brazil.
authors.forename: Nádja N
authors.initials: NN
authors.lastname: Negreiros
authors.affiliation: E.B. Pinto, PT, PhD, Bahiana School of Medicine and Public Health.
authors.forename: Elen B
authors.initials: EB
authors.lastname: Pinto
authors.affiliation: J. Oliveira-Filho, MD, MS, PhD, Postgraduate Program in Health Sciences, School of Medicine, Federal University of Bahia.
authors.forename: Jamary
authors.initials: J
authors.lastname: Oliveira-Filho
mesh_terms: D000058:Accidental Falls; D000368:Aged; D019540:Area Under Curve; D005260:Female; D005684:Gait / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications* / Q000503:physiopathology*; D004856:Postural Balance / Q000502:physiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D057566:Self Report