title: Fall-related activity avoidance in relation to a history of falls or near falls, fear of falling and disease severity in people with Parkinson's disease.
abstract: BACKGROUND
  There is limited knowledge concerning fall-related activity avoidance in people with Parkinson's disease (PD); such knowledge would be of importance for the development of more efficient PD-care and rehabilitation. This study aimed to examine how fall-related activity avoidance relates to a history of self-reported falls/near falls and fear of falling (FOF) as well as to disease severity in people with PD.
  
  
  METHODS
  Data were collected from 251 (61 % men) participants with PD; their median (min-max) age and PD duration were 70 (45-93) and 8 (1-43) years, respectively. A self-administered postal survey preceded a home visit which included observations, clinical tests and interview-administered questionnaires. Fall-related activity avoidance was assessed using the modified Survey of Activities and Fear of Falling in the Elderly (mSAFFE) as well as by using a dichotomous (Yes/No) question. Further dichotomous questions concerned: the presence of FOF and the history (past 6 months) of falls or near falls, followed by stating the number of incidents. Disease severity was assessed according to the Hoehn and Yahr (HY) stages.
  
  
  RESULTS
  In the total sample (n = 251), 41 % of the participants reported fall-related activity avoidance; the median mSAFFE score was 22. In relation to a history of fall, the proportions of participants (p < 0.001) that reported fall-related activity avoidance were: non-fallers (30 %), single fallers (50 %) and recurrent fallers, i.e. ≥ 2 falls (57 %). Among those that reported near falls (but no falls), 51 % (26 out of 51) reported fall-related activity avoidance. Of those that reported FOF, 70 % reported fall-related activity avoidance. Fall-related activity avoidance ranged from 24 % in the early PD-stage (HY I) to 74 % in the most severe stages (HY IV-V).
  
  
  CONCLUSIONS
  Results indicate that fall-related activity avoidance may be related to a history of self-reported falls/near falls, FOF and disease severity in people with PD. Importantly, fall-related activity avoidance is reported among those that do not fall and already in mild PD-stages (HY I-II). Although further studies are needed, our findings indicate that fall-related activity avoidance needs to be addressed early in order to prevent sedentary behavior and participation restrictions.
authors.affiliation: Department of Health Sciences, Lund University, PO Box 157, SE-221 00, Lund, Sweden. manzur.kader@med.lu.se.
authors.forename: Manzur
authors.initials: M
authors.lastname: Kader
authors.affiliation: Department of Health Sciences, Lund University, PO Box 157, SE-221 00, Lund, Sweden.
authors.forename: Susanne
authors.initials: S
authors.lastname: Iwarsson
authors.affiliation: Department of Clinical Sciences, Lund University, Lund, Sweden.|Department of Clinical Sciences, Section for Neurology, Skåne University Hospital, Lund, Sweden.|Department of Neurology, Central Hospital, Bremerhaven, Germany.
authors.forename: Per
authors.initials: P
authors.lastname: Odin
authors.affiliation: Department of Health Sciences, Lund University, PO Box 157, SE-221 00, Lund, Sweden.|Memory Clinic, Skåne University Hospital, Malmö, Sweden.
authors.forename: Maria H
authors.initials: MH
authors.lastname: Nilsson
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D005239:Fear / Q000523:psychology*; D005260:Female; D006801:Humans; D055809:Illness Behavior; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications / Q000523:psychology*; D012720:Severity of Illness Index
keywords: Activity avoidance; Falls; Fear of falling; Hoehn and Yahr stages; Near falls; Parkinson’s disease; mSAFFE