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Fear of falling, falls and near falls in Parkinson’s disease

Lindholm, Beata LU (2017)
Abstract (Swedish)

 




Abstract
ABSTRACT
AIM: The overall aim of this longitudinal PhD project was to gain increased knowledge about factors associated with fear of falling (FOF) falls and near falls, as well as to contribute to improved clinical fall prediction for people
with mild Parkinson’s disease (PD).
METHODS: People diagnosed with PD and receiving care at the university hospital outpatient neurology clinic were assessed during the “on” phase using a broad range of rating scales and clinical tests targeting balance and gait problems as well as motor and non-motor symptoms. The participants then registered all prospective falls and near falls for six months by using a diary.
RESULTS: Paper I identified everyday walking difficulties as the strongest... (More)
ABSTRACT
AIM: The overall aim of this longitudinal PhD project was to gain increased knowledge about factors associated with fear of falling (FOF) falls and near falls, as well as to contribute to improved clinical fall prediction for people
with mild Parkinson’s disease (PD).
METHODS: People diagnosed with PD and receiving care at the university hospital outpatient neurology clinic were assessed during the “on” phase using a broad range of rating scales and clinical tests targeting balance and gait problems as well as motor and non-motor symptoms. The participants then registered all prospective falls and near falls for six months by using a diary.
RESULTS: Paper I identified everyday walking difficulties as the strongest factor independently associated with FOF, followed by independence in daily activities, functional balance, and fatigue. Paper II identified FOF to be the strongest factor independently associated with prospective falls and/or near falls, followed by history of near falls, and retropulsion during an unexpected shoulder pull. Paper III showed that the discriminate ability of a recently suggested clinical 3-Step Falls Prediction Model (3-step model) is acceptable and better than that of single predictors. Extended analyses showed that a new model for prediction of falls and/or near falls (including history of near falls, tandem gait and retropulsion) had better discriminant ability than the 3-step model. Paper IV found that different standardizations of the 10-Meter Walk Test (10MWT) for measuring gait speed yielded very similar results, including cut-off scores for future falls, suggesting that the clinical conduct of 10MWT can be simplified.
CONCLUSIONS: Everyday walking difficulties should be a primary target when attempting to reduce FOF in mild PD, and balance training should focus on self-generated perturbations caused by everyday activities rather
than external perturbations. Moreover, FOF and asking about prior near falls seem to be important issues for prediction of falls and near falls early in the disease course. The 3-step model can be recommended as a clinical
prediction tool but a new model may be considered a promising alternative. Clinical gait speed measurement by the 10MWT can be simplified by not using acceleration distance or repeated trials in mild PD.
(Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • docent Nyholm, Dag, Uppsala Universitet
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Parkinson’s disease, Fear of falling, Self-Efficacy, Falls, Near falls, Walking, Balance, Prediction, Validation studies, Rehabilitation, Prevention
pages
84 pages
publisher
Lund University, Faculty of Medicine
defense location
Kvinnoklinikens aula, Skånes Universitetssjukhus i Malmö
defense date
2017-03-31 09:00
ISBN
978-91-7619-420-1
language
English
LU publication?
yes
id
0dbdd09b-d26a-43c1-90de-6d2e246f9bf8
date added to LUP
2017-03-09 19:35:38
date last changed
2017-03-16 15:27:00
@phdthesis{0dbdd09b-d26a-43c1-90de-6d2e246f9bf8,
  abstract     = {ABSTRACT<br/>AIM: The overall aim of this longitudinal PhD project was to gain increased knowledge about factors associated with fear of falling (FOF) falls and near falls, as well as to contribute to improved clinical fall prediction for people<br/>with mild Parkinson’s disease (PD).<br/>METHODS: People diagnosed with PD and receiving care at the university hospital outpatient neurology clinic were assessed during the “on” phase using a broad range of rating scales and clinical tests targeting balance and gait problems as well as motor and non-motor symptoms. The participants then registered all prospective falls and near falls for six months by using a diary.<br/>RESULTS: Paper I identified everyday walking difficulties as the strongest factor independently associated with FOF, followed by independence in daily activities, functional balance, and fatigue. Paper II identified FOF to be the strongest factor independently associated with prospective falls and/or near falls, followed by history of near falls, and retropulsion during an unexpected shoulder pull. Paper III showed that the discriminate ability of a recently suggested clinical 3-Step Falls Prediction Model (3-step model) is acceptable and better than that of single predictors. Extended analyses showed that a new model for prediction of falls and/or near falls (including history of near falls, tandem gait and retropulsion) had better discriminant ability than the 3-step model. Paper IV found that different standardizations of the 10-Meter Walk Test (10MWT) for measuring gait speed yielded very similar results, including cut-off scores for future falls, suggesting that the clinical conduct of 10MWT can be simplified.<br/>CONCLUSIONS: Everyday walking difficulties should be a primary target when attempting to reduce FOF in mild PD, and balance training should focus on self-generated perturbations caused by everyday activities rather<br/>than external perturbations. Moreover, FOF and asking about prior near falls seem to be important issues for prediction of falls and near falls early in the disease course. The 3-step model can be recommended as a clinical<br/>prediction tool but a new model may be considered a promising alternative. Clinical gait speed measurement by the 10MWT can be simplified by not using acceleration distance or repeated trials in mild PD.<br/>},
  author       = {Lindholm, Beata},
  isbn         = {978-91-7619-420-1},
  keyword      = {Parkinson’s disease, Fear of falling, Self-Efficacy, Falls, Near falls, Walking, Balance, Prediction, Validation studies, Rehabilitation, Prevention},
  language     = {eng},
  pages        = {84},
  publisher    = {Lund University, Faculty of Medicine},
  school       = {Lund University},
  title        = {Fear of falling, falls and near falls in Parkinson’s disease},
  year         = {2017},
}