Author Response

We appreciate the thoughtful comments of Dr Norton in her reading of our recent article and welcome the opportunity to respond. During the evolution of this research and writing of this manuscript, our research group had many conversations regarding the appropriate terminology to describe the examination of the potential for falls in Parkinson disease (PD). Some of Norton's comments regarding the terminology echoed some of our own conversations. Rather than euphemistically use the terms “identification” or “imbalance,” we consciously chose the terms “diagnosis” and “fall risk” in an effort to directly address the problem that we hope can be treated. In response, we wish to acknowledge Dr Norton's concerns but not debate whether “diagnosis” or “fall risk” were appropriate terms, but rather to clarify critical elements for optimal clinical decision making in the management of people with PD and our research agenda toward this end.

When physical therapists examine a person with a progressive neurologic disease such as PD, their mode of practice should encompass traditional tertiary preventive care of the current problems (eg, treating bradykinesia during gait, addressing bed mobility limitations).¹ In addition, optimal care should encompass secondary prevention; that is, awareness and treatment of complications of the disease process that are likely to occur in the future (eg, falls).^2,3

As with many clinical decisions, in the context of PD, diagnosis or identification of a movement problem amenable to treatment is an imprecise endeavor. In order to provide the appropriate secondary preventive care, physical therapists must have accurate clinical measures to rule in or rule out target conditions that may respond to preventive or risk reduction treatments. Toward this end, our study sought to advocate for critical analysis of clinical balance test choice and interpretation rather than the blind acceptance of an individual test or cutoff score.

Above all concerns regarding terminology, the clinical relevance of being able to accurately apply a label to a patient that directs treatment⁴ cannot be understated. Without question, further work remains. Prospective confirmation of the accuracy of these tests is needed, as are examinations of the efficacy of fall prevention and fall-risk reduction programs for persons with PD.

• Physical Therapy