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

Abstract: ABSTRACTAIM: 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 peoplewith 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 ratherthan 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 clinicalprediction 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.