Recurrent Falls in Parkinson's Disease: A Systematic Review

Clinical and Rehabilitation Sciences Research Group, Faculty of Health Sciences, The University of Sydney, P.O. Box 170, Lidcombe, NSW 1825, Australia.
Parkinson's Disease (Impact Factor: 2.01). 03/2013; 2013(2):906274. DOI: 10.1155/2013/906274
Source: PubMed


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.

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    • "Differentiation between PD fallers and PD nonfallers was based on self-reporting: falls were defined as an event thatcaused the patient to come to rest unintentionally on the ground or lower level[22]. Participants that had fallen more than once during the previous 12 months were allocated to the " fallers " group[8]. Each participant's assessment of their clinical improvement ( " better, " " worse, " or " unchanged " ) was recorded on Day 8 (after the final intervention). "
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    ABSTRACT: Postural instability in Parkinson’s disease (PD) increases the risk of falls and is not improved by pharmacological therapy. Objective. We performed a double-blind, randomized sham-controlled study to test the effects of stochastic resonance (whole body vibration) therapy on postural stability in PD. Methods. Fifty-six PD participants were allocated to either experimental or sham groups. The experimental group received four series of vibration over eight days, with each series consisting of six stimulus trains of 60-second duration using a randomized whole body vibration. Participants allocated to the control group received a sham treatment. Results. Within-group analysis revealed that postural stability in the experimental group improved by 17.5% ( p = 0.005 ) comparing experimental and sham groups. The between-group analysis of change after treatment comparing both groups also showed a significant improvement of postural stability ( p = 0.03 ). Only in the within-group analysis several items were improved after Bonferroni correction, too, rigor 41.6% ( p = 0.001 ), bradykinesia 23.7% ( p = 0.001 ), tremor 30.8% ( p = 0.006 ), and U P D R S I I I sum score 23.9% ( p = 0.000 ), but did not reach the level of significance in the between-group analysis. Conclusions. Stochastic resonance therapy significantly enhanced postural stability even in individuals with increased risk of falling. Thus it offers a potential supplementation to canonical treatments of PD.
    Full-text · Article · Jan 2016 · Parkinson's Disease
    • "© 2015 – IOS Press and the authors. All rights reserved serious consequences, such as fractures, fear of falling and increased caregiver burden [1]. Several risk factors for falling have been identified, including falling in the last year [2] [3] [4] [5], disease severity [2] [3] [4], freezing of gait (FOG) [4] [5] [6] [7], poor balance [4] [6] [7], impaired mobility [6], fear of falling [8] and cognitive impairment [4] [7]. "
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    ABSTRACT: Background: Predictors of falls in people with Parkinson's disease (PD) who have not previously fallen are yet to be identified. Objectives: We aimed to identify predictors of all falls and recurrent falls in people with PD who had not fallen in the previous year and to explore the timing of falls in a 12-month follow-up period. Methods: Participants with PD (n = 130) were assessed by disease-specific, self-report and balance measures. Falls were recorded prospectively for 12 months. Univariate and multivariate analyses were performed. Kaplan-Meier survival analysis was used to investigate time to falling. Results: Forty participants (31%) had ≥1 fall during follow-up and 21 (16%) had ≥2 falls. Disability, reduced balance confidence and greater concern about falling were associated with ≥1 fall in univariate analyses. Additionally, PD duration and severity, freezing of gait and impaired balance were associated with ≥2 falls (p < 0.05). Disability (Schwab and England scale, Odds Ratio [OR] = 0.56 per 10 points increase; 95% confidence interval [CI] 0.39-0.80; p = 0.002) was associated with ≥1 fall in the final multivariate model (area under the receiver operating characteristic curve [AUC] = 0.65; 95% CI 0.55-0.76; p = 0.005). Disability (Unified Parkinson's Disease Rating Scale activities of daily living, OR = 1.20; 95% CI 1.07-1.34; p = 0.001) and levodopa equivalent dose (OR = 1.11 per 100 mg increase; 95% CI 0.95-1.30; p = 0.19) were associated with ≥2 falls in the final multivariate model (AUC = 0.72; 95% CI 0.60-0.84, p = 0.001).Recurrent fallers experienced their first fall earlier than single fallers (p < 0.05). Conclusions: Self-reported disability was the strongest single predictor of all falls and recurrent falls.
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    • "People with FOG commonly demonstrate significant gait variability during straight line walking, along with reduced step length and often leg trembling during FOG episodes [6]. A frequently disabling complication of PD, FOG is associated with recurrent falls [7] [8] [9], thus placing the individual at significant risk for experiencing devastating sequelae such as fractures and immobility [10]. While it is understood that cessation of gait during FOG may lead to falls, it is currently unclear if individuals with FOG (PD + FOG) have "
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    ABSTRACT: Freezing of gait (FOG) is a relatively common and remarkably disabling impairment associated with Parkinson disease (PD). Laboratory-based measures indicate that individuals with FOG (PD+FOG) have greater balance deficits than those without FOG (PD-FOG). Whether such differences also can be detected using clinical balance tests has not been investigated. We sought to determine if balance and specific aspects of balance, measured using Balance Evaluation Systems Test (BESTest), differs between PD+FOG and PD-FOG. Furthermore, we aimed to determine if time-efficient clinical balance measures (i.e. Mini-BESTest, Berg Balance Scale (BBS)) could detect balance differences between PD+FOG and PD-FOG. Balance of 78 individuals with PD, grouped as either PD+FOG (n=32) or PD-FOG (n=46), was measured using the BESTest, Mini-BESTest, and BBS. Between-groups comparisons were conducted for these measures and for the six sections of the BESTest using analysis of covariance. A PD composite score was used as a covariate. Controlling for motor sign severity, PD duration, and age, PD+FOG had worse balance than PD-FOG when measured using the BESTest (p=0.008, F=7.35) and Mini-BESTest (p=0.002, F=10.37), but not the BBS (p=0.27, F=1.26). BESTest section differences were noted between PD+FOG and PD-FOG for reactive postural responses (p<0.001, F=14.42) and stability in gait (p=0.003, F=9.18). The BESTest and Mini-BESTest, which specifically assessed reactive postural responses and stability in gait, were more likely than the BBS to detect differences in balance between PD+FOG and PD-FOG. Because it is more time efficient to administer, the Mini-BESTest may be the preferred tool for assessing balance deficits associated with FOG. Copyright © 2015 Elsevier B.V. All rights reserved.
    Full-text · Article · Jun 2015 · Gait & posture
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