Journal of Neurology

, Volume 256, Issue 5, pp 742–749 | Cite as

Balance confidence and functional mobility are independently associated with falls in people with Parkinson’s disease

Original Communication

Abstract

The present study aimed to examine the association of falls with self-perceived balance confidence level, and balance and mobility performance in patients with Parkinson’s disease (PD). Forty-nine healthy subjects and 71 subjects with PD completed the study. Among the PD patients, 33 (46%) were fallers and 38 were non-fallers. All subjects were tested with the activities-specific balance confidence scale (ABC), one-leg-stance test (OLS), and timed-up-and-go test (TUG). Results indicated that PD fallers had significantly lower ABC scores, shorter OLS times and longer times to complete TUG than PD non-fallers (P < 0.05). Having a high ABC score (>80) was significantly associated with a lower fall risk, after adjusting for age, gender, and duration of PD, and for depression [odds ratio (OR) = 0.06, P = 0.020]. For performance-based measures of balance and mobility, a longer TUG time (≥16 s) was independently associated with increased risk of falling after controlling for relevant factors (OR = 3.86, P = 0.043); OLS time, however, was not significantly associated with falls. A lower self-perceived balance confidence level and a prolonged time to complete TUG were associated with increased risk of falling in patients with PD. Interventions to improve these modifiable risk factors could be useful in reducing future falls in the PD population and will require further study.

Keywords

Balance Balance confidence Falling Parkinson’s disease Risk factors 

References

  1. 1.
    Adkin AL, Frank JS, Jog MS (2003) Fear of falling and postural control in Parkinson’s disease. Mov Disord 18:496–502PubMedCrossRefGoogle Scholar
  2. 2.
    Ashburn A, Fazakarley L, Ballinger C, Pickering R, McLellan LD, Fitton C (2007) A randomized controlled trial of a home based exercise programme to reduce the risk of falling among people with Parkinson’s disease. J Neurol Neurosurg Psychiatry 78:678–684PubMedCrossRefGoogle Scholar
  3. 3.
    Ashburn A, Stack E, Pickering RM, Ward CD (2001) Predicting fallers in a community-based sample of people with Parkinson’s disease. Gerontology 47:277–281PubMedCrossRefGoogle Scholar
  4. 4.
    Behrman AL, Light KE, Flynn SM, Thigpen MT (2002) Is the functional reach test useful for identifying falls risk among individuals with Parkinson’s disease? Arch Phys Med Rehabil 83:538–542PubMedCrossRefGoogle Scholar
  5. 5.
    Belgen B, Beninato M, Sullivan PE, Narielwalla K (2006) The association of balance capacity and falls self-efficacy with history of falling in community-dwelling people with chronic stroke. Arch Phys Med Rehabil 87:554–561PubMedCrossRefGoogle Scholar
  6. 6.
    Bloem BR, Grimbergen YAM, Cramer M, Willemsen M, Zwinderman AH (2001) Prospective assessment of falls in Parkinson’s disease. J Neurol 248:950–958PubMedCrossRefGoogle Scholar
  7. 7.
    Bloem BR, van Vugt JPP, Beckley DJ (2001) Postural instability and falls in Parkinson’s disease. Adv Neurol 87:209–223PubMedGoogle Scholar
  8. 8.
    Brouwer BJ, Walker C, Rydahl SJ, Culham EG (2003) Reducing fear of falling in seniors through education and activity programs: a randomized trial. JAGS 51:829–834CrossRefGoogle Scholar
  9. 9.
    Charlett A, Weller C, Dobbs SM et al (1997) What makes a faller in early parkinsonism? Eur Neurol 38:312–314PubMedCrossRefGoogle Scholar
  10. 10.
    Chiu AYY, Au-Yueng SSY, Lo SK (2003) A comparison of four functional tests in discriminating fallers from non-fallers in older people. Disabil Rehabil 25:45–50PubMedCrossRefGoogle Scholar
  11. 11.
    Fletcher PC, Hirdes JP (2004) Restriction in activity associated with fear of falling among community-based seniors using home care services. Age Ageing 33:273–279PubMedCrossRefGoogle Scholar
  12. 12.
    Folstein MF, Folstein SE, MeHugh PR (1975) Mini-mental state: a practical method for grading the state of patients for the clinician. J Psychiatr Res 12:189–198PubMedCrossRefGoogle Scholar
  13. 13.
    Franchignoni F, Martignoni E, Ferriero G, Pasetti C (2005) Balance and fear of falling in Parkinson’s disease. Parkinsonism Relat Disord 11:427–433PubMedCrossRefGoogle Scholar
  14. 14.
    Friedman SM, Munoz B, West SK, Rubin GS, Fried LP (2002) Falls and fear of falling: which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention. JAGS 50:1329–1335CrossRefGoogle Scholar
  15. 15.
    Gray P, Hildebrand K (2000) Fall risk factors in Parkinson’s disease. J Neurosci Nurs 32:222–228PubMedGoogle Scholar
  16. 16.
    Grisso JA, Kelsey JL, Strom BL, Chiu GY, Maislin G, O’Brien LA, Hoffman S, Kaplan F (1991) Risk factors for falls as a cause of hip fracture in women. The Northeast Hip Fracture Study Group. New Engl J Med 324:1326–1331PubMedCrossRefGoogle Scholar
  17. 17.
    Hely MA, Morris JG, Traficante R, Reid WG, O’Sullivan DJ, Williamson PM (1999) The Sydney multi-centre study of Parkinson’s disease: progression and mortality at 10 years. J Neurol Neurosurg Psychiatry 67:300–307PubMedCrossRefGoogle Scholar
  18. 18.
    Hoehn MM, Yahr MD (1967) Parkinsonism: onset, progression and mortality. Neurology 17:427–442PubMedGoogle Scholar
  19. 19.
    Hughes AJ, Daniel SE, Kilford L, Lees AJ (1992) Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 55:181–184PubMedCrossRefGoogle Scholar
  20. 20.
    Jacobs JV, Horak FB, Tran VK, Nutt JG (2006) Multiple balance tests improve the assessment of postural stability in subjects with Parkinson’s disease. J Neurol Neurosurg Psychiatry 77:322–326PubMedCrossRefGoogle Scholar
  21. 21.
    Johnnell O, Melton J, Atkinson E et al (1992) Fracture risk in patients with Parkinsonism: a population-based study in Olmsted country, Minnesota. Age Ageing 21:32–38CrossRefGoogle Scholar
  22. 22.
    Koller WC, Glatt S, Vetere-Overfield B, Hassanein R (1989) Falls and Parkinson’s disease. Clin Neuropharmacol 12:98–105PubMedGoogle Scholar
  23. 23.
    Lamb SE, Ferrucci L, Volapto S, Fried LP, Guralnik JM (2003) Risk factors for falling in home-dwelling older women with stroke. The women’s health and aging study. Stroke 34:494–501PubMedCrossRefGoogle Scholar
  24. 24.
    Mak MK, Lau AL, Law FS, Cheung CC, Wong IS (2007) Validation of the Chinese translated activities-specific balance confidence scale. Arch Phys Med Rehabil 88:496–503PubMedCrossRefGoogle Scholar
  25. 25.
    Mathias S, Nayak U, Isaacs B (1986) Balance in elderly patients: the “Get-up and Go” test. Arch Phys Med Rehabil 67:387–389PubMedGoogle Scholar
  26. 26.
    Morris S, Morris ME, Iansek R (2001) Reliability of measurements obtained with the timed “Up & Go” test in people with Parkinson disease. Phys Ther 81:810–818PubMedGoogle Scholar
  27. 27.
    Myers AM, Fletcher PC, Myers AH, Sherk W (1998) Discriminative and evaluative properties of the activities-specific balance confidence (ABC) scale. J Gerontol A Biol Sci Med Sci 53A:M287–M294Google Scholar
  28. 28.
    Okumiya K, Matsubayashi K, Nakamura T, Fujisawa M, Osaki Y, Doi Y (1998) The timed “Up & Go” test is a useful predictor of falls in community-dwelling older people. J Am Geriatr Soc 46:928–930PubMedGoogle Scholar
  29. 29.
    Oude Nijhuis LB, Arends S, Borm GF, Visser JE, Bloem BR (2007) Balance confidence in Parkinson’s disease. Mov Disord 22:2450–2451PubMedCrossRefGoogle Scholar
  30. 30.
    Pickering RM, Grimbergen YAM, Rigney U, Ashburn A, Mazibrada G, Wood B, Gray P, Kerr G, Bloem BR (2007) A meta-analysis of six prospective studies of falling in Parkinson’s disease. Mov Disord 22:1892–1900PubMedCrossRefGoogle Scholar
  31. 31.
    Podsiadlo D, Richardson S (1991) The timed “Up & Go”: a test of basic functional mobility for frail elderly. J Am Geriatr Soc 39:142–148PubMedGoogle Scholar
  32. 32.
    Powell LE, Myers AM (1995) The activities-specific balance confidence (ABC) scale. J Gerontol A Biol Sci Med Sci 50A:M28–M34PubMedGoogle Scholar
  33. 33.
    Protas EJ, Mitchell K, William A, Qureshy H, Caroline K, Lai EC (2005) Gait and step training to reduce falls in Parkinson’s disease. Neurorehabilitation 20:183–190PubMedGoogle Scholar
  34. 34.
    Robinson K, Dennison A, Roalf D, Noorrigian J, Heather C, Bunting-Perry L, Moberg P, Kleiner-Fisman G, Martine R, Duda J, Jaggi J, Stern M (2005) Falling risk factors in Parkinson’s disease. Neurorehabilitation 20:169–182PubMedGoogle Scholar
  35. 35.
    Salbach NM, Mayo NE, Robichaud-Ekstrand S, Hanley JA, Richards CL, Wood-Dauphinee S (2005) The effect of a task-oriented walking intervention on improving balance self-efficacy poststroke: a randomized, controlled trial. JAGS 53:576–582CrossRefGoogle Scholar
  36. 36.
    Shumway-Cook A, Brauer S, Wollacott M (2000) Predicting the probability for falls in community-dwelling older adults using the timed up and go test. Phys Ther 80:896–903PubMedGoogle Scholar
  37. 37.
    Smithson F, Morris ME, Iansek R (1998) Performance on clinical tests of balance in Parkinson’s disease. Phys Ther 78:577–592PubMedGoogle Scholar
  38. 38.
    Tennstedt S, Howland J, Lachman M, Peterson E, Kasten L, Jette A (1998) A randomized, controlled trial of a group intervention to reduce fear of falling an associated activity restriction in older adults. J Gerontol B Psychol Sci Soc Sci 53B:P384–P392Google Scholar
  39. 39.
    Tinetti ME, Speechley M, Ginter SF (1988) Risk factors for falls among elderly persons living in the community. N Eng J Med 319:1701–1707Google Scholar
  40. 40.
    Whitney SL, Wrisley DM, Marchetti GF, Gee MA, Redfern MS, Furman JM (2005) Clinical measurement of sit-to-stand performance in people with balance disorders: validity of data for the five-times-sit-to-stand test. Phys Ther 85:1034–1045PubMedGoogle Scholar
  41. 41.
    Wood BH, Bilclough JA, Boweon A, Waler RW (2002) Incidence and prediction of falls in Parkinson’s disease: a prospective multidisciplinary study. J Neurol Neurosurg Psychiatry 72:721–725PubMedCrossRefGoogle Scholar
  42. 42.
    Yesavage JA, Brink TL, Rose TL et al (1983) Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 17:37–49CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  1. 1.Dept. of Rehabilitation SciencesHong Kong Polytechnic UniversityHong KongChina

Personalised recommendations