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Predicting the Risk of Falls for People With PD
- Jul 08 2013
With two simple questions — how many times a person has had a fall in the past year, and how many times he or she has experienced freezing in the last month — combined with a test to measure walking speed, doctors can accurately predict the risk of falls for individuals with Parkinson’s disease (PD), according to research published in the May issue of Movement Disorders.
Australian researchers led by Victor S.C. Fung, Ph.D., F.R.A.C.P., at the University of Sydney, worked with 205 volunteers with PD, all of whom lived at home and were able to walk independently with or without an aid such as a cane. Study participants were about 67 years old on average, and had mild to moderate disease severity. No participants had significant cognitive impairment.
At the beginning of the study, Dr. Fung and colleagues visited participants at home, while on PD medication. The team took medical histories, asked questions about exercise and administered tests of muscle strength, balance and mobility. Then, for six months, study participants recorded any falls in a diary.
- During the six-month follow-up period, 120 out of 205 participants (59 percent) fell at least once.
- Those who fell during the follow-up period had experienced more than 42 falls on average in the year prior to the study, whereas those who did not fall reported no falls or one fall during that time.
- Of those who fell during the follow-up period, 54 percent experienced freezing of gait — the sudden inability to move while walking — in the month prior to the study. In contrast, of those who didn’t fall, only 19 percent experienced freezing of gait the month before.
- People whose comfortable walking speed was slower than 2.5 miles/hour were more likely to fall.
- Combining all these factors into a simple questionnaire, the researchers found they could accurately predict the probability that someone might fall in the coming six months as low (17 percent probability), medium (51 percent probability) or high (85 percent probability).
What Does It Mean?
PD movement symptoms, including stiffness and balance difficulties, as well as nonmotor symptoms such as low blood pressure when standing up after sitting, increase the risk of falls. In fact, some 60 percent of people with PD experience at least one fall each year. The resulting injuries may require care in a hospital, can compromise a person’s mobility and quality of life and can increase risk of death.
Trying to prevent falls should be the goal of people with PD, their doctors and care partners. In fact, Medicare encourages clinicians to document fall assessment, and fall prevention plans. The study authors suggest a simple assessment that can be carried out during a routine doctor’s visit to help both doctors and people with PD be aware of the risk of falls.
A strength of the study is the relatively large number of participants. Also, the algorithm proposed here may predict fall risk for each individual. All people with PD should be aware of the many strategies for preventing falls.
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Reference: Paul SS, Canning CG, Sherrington C, Lord SR, Close JCT, Fung VSC (2013) Three simple clinical tests to accurately predict falls in people with Parkinson's disease. Mov Disord 28:655–662. DOI: 10.1002/mds.25404 http://dx.doi.org/10.1002/mds.25404
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Source Date: Jul 08 2013