Failing in Parkinson disease - Identifying and prioritizing risk factors in recurrent fallers

University of Houston, Houston, Texas, United States
American Journal of Physical Medicine & Rehabilitation (Impact Factor: 2.2). 09/2007; 86(8):621-32. DOI: 10.1097/PHM.0b013e311611583
Source: PubMed


To identify falling risk factors in a study population of recurrent fallers compared with nonfallers who have Parkinson disease, and to prioritize falling risk factors in this patient population to target them for modification.
Twenty-three recurrent fallers and 25 nonfallers who have Parkinson disease were recruited, and they participated in a comprehensive assessment probing for the presence of falling risk factors. To identify falling risk factors, a group comparative design was used to compare recurrent fallers and nonfallers across an array of variables. To prioritize those risk factors, modeling using recursive partitioning was performed, entering into the model falling, risk factors identified in this and other studies that were considered potentially modifiable.
A specific profile of variables distinguished recurrent fallers who have Parkinson disease in our study population: higher disease severity, higher level of motor impairment, higher level of disability, impaired leg agility or lower-limb coordination, impaired ability to arise from a chair or compromised proximal lower-limb motor control, impaired ambulation, impaired motor planning of the hands and feet, impaired dynamic balance as measured by ability to walk in tandem, and fear of falling. Recursive partitioning prioritized three risk factors: impaired ambulation, impaired lower-limb motor planning, and orthostasis.
In this study, an idiosyncratic falling risk factor profile was demonstrated among our subjects who have Parkinson disease. Three variables were prioritized for potential modification: impaired ambulation, impaired lower-limb motor planning, and orthostasis.

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Available from: Paul J Moberg, Apr 23, 2015
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    • "Such work would aid in developing an understanding of the causes of recurrent falls. In addition, consideration of factors associated with recurrent falling reported in retrospective studies, including lower limb muscle power [52], impaired motor planning [14, 53], and urinary urge incontinence [42], requires prospective investigation to confirm these relationships. Similarly, the role of medication-related side effects, such as dyskinesia [2, 14] and orthostatic hypotension [54], requires further prospective evaluation regarding their role in recurrent falls in PD. "
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    ABSTRACT: Most people with Parkinson's disease (PD) fall and many experience recurrent falls. The aim of this review was to examine the scope of recurrent falls and to identify factors associated with recurrent fallers. A database search for journal articles which reported prospectively collected information concerning recurrent falls in people with PD identified 22 studies. In these studies, 60.5% (range 35 to 90%) of participants reported at least one fall, with 39% (range 18 to 65%) reporting recurrent falls. Recurrent fallers reported an average of 4.7 to 67.6 falls per person per year (overall average 20.8 falls). Factors associated with recurrent falls include: a positive fall history, increased disease severity and duration, increased motor impairment, treatment with dopamine agonists, increased levodopa dosage, cognitive impairment, fear of falling, freezing of gait, impaired mobility and reduced physical activity. The wide range in the frequency of recurrent falls experienced by people with PD suggests that it would be beneficial to classify recurrent fallers into sub-groups based on fall frequency. Given that there are several factors particularly associated with recurrent falls, fall management and prevention strategies specifically targeting recurrent fallers require urgent evaluation in order to inform clinical practice.
    Parkinson's Disease 03/2013; 2013(2):906274. DOI:10.1155/2013/906274 · 2.01 Impact Factor
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    • "RP is also becoming more prevalent in the examination of treatment outcomes in medical fields other than genetics. Dennison et al. (2007) used RP to identify risk profiles in patients with Parkinson's disease who needed physical therapy, and Wang et al. (2006) used RP to identify which pediatric patients and their caretakers are least likely to comply with physicians instructions. In general, RP results have been used to identify variables that merit increased attention in subsequent research, to suggest treatment guidelines, and to identify potential risk factors in a wide range of fields. "
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    ABSTRACT: We investigated the predictive power of morphological features in 224 autistic patients and 224 matched-pairs controls. To assess the relationship between the morphological features and autism, we used the receiver operator curves (ROC). In addition, we used recursive partitioning (RP) to determine a specific pattern of abnormalities that is characteristic for the difference between autistic children and typically developing controls. The present findings showed that morphological features are significantly increased in patients with autism. Using ROC and RP, some of the morphological measures also led to strong predictive accuracy. Facial asymmetry, multiple hair whorls and prominent forehead significantly differentiated patients with autism from controls. Future research on multivariable risk prediction models may benefit from the use of morphological features. Electronic supplementary material The online version of this article (doi:10.1007/s10803-012-1554-4) contains supplementary material, which is available to authorized users.
    Journal of Autism and Developmental Disorders 06/2012; 43(1). DOI:10.1007/s10803-012-1554-4 · 3.06 Impact Factor
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    • "The estimated prevalence of falls in PD ranges from 40 to 90% and increases with the duration of follow-up [4, 5, 11–16]. It is estimated that 45–50% of falls in this population occur when walking [5, 17], with balance and walking deficits commonly identified as risk factors for falls [5, 10–12, 14, 18, 19]. Reduced quality of life is also associated with balance and gait abnormalities in PD, including festination and freezing of gait [2, 20–24]. "
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    ABSTRACT: Gait impairments in Parkinson's disease (PD) are exacerbated under dual-task conditions requiring the simultaneous performance of cognitive or motor tasks. Dual-task walking deficits impact functional mobility, which often requires walking while performing concurrent tasks such as talking or carrying an object. The consequences of gait impairments in PD are significant and include increased disability, increased fall risk, and reduced quality of life. However, effective therapeutic interventions for dual-task walking deficits are limited. The goals of this narrative review are to describe dual-task walking deficits in people with PD, to discuss motor and cognitive factors that may contribute to these deficits, to review potential mechanisms underlying dual-task deficits, and to discuss the effect of therapeutic interventions on dual-task walking deficits in persons with PD.
    01/2012; 2012(2090-8083):918719. DOI:10.1155/2012/918719
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