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Comparison of Self-report and Performance-Based Balance Measures for Predicting Recurrent Falls in People With Parkinson Disease: Cohort Study

Lorena R.S. Almeida, Guilherme T. Valenca, Nádja N. Negreiros, Elen B. Pinto, Jamary Oliveira-Filho
DOI: 10.2522/ptj.20150168 Published 1 July 2016
Lorena R.S. Almeida
L.R.S. Almeida, PT, MSc, Movement Disorders and Parkinson's Disease Clinic, Roberto Santos General Hospital/SESAB, Rua Direta do Saboeiro, s/n-Cabula, 41180-780, Salvador, Bahia, Brazil; Postgraduate Program in Health Sciences, School of Medicine, Federal University of Bahia, Salvador, Bahia, Brazil; and Behavior and Motor Learning Research Group, Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil.
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Guilherme T. Valenca
G.T. Valenca, MD, PhD, Movement Disorders and Parkinson's Disease Clinic, Roberto Santos General Hospital/SESAB, and Health Sciences Center, Federal University of Reconcavo of Bahia, Santo Antônio de Jesus, Bahia, Brazil.
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Nádja N. Negreiros
N.N. Negreiros, RN, Movement Disorders Clinic, State of Bahia Health Attention Center for the Elderly/SESAB, Salvador, Bahia, Brazil.
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Elen B. Pinto
E.B. Pinto, PT, PhD, Bahiana School of Medicine and Public Health.
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Jamary Oliveira-Filho
J. Oliveira-Filho, MD, MS, PhD, Postgraduate Program in Health Sciences, School of Medicine, Federal University of Bahia.
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Abstract

Background Balance confidence and fear of falling are factors associated with recurrent falls in people with Parkinson disease (PD). However, the accuracy for predicting falls on the basis of self-report measures has not been widely investigated.

Objective The study objectives were: (1) to compare the accuracy of the Activities-specific Balance Confidence Scale (ABC) and the Falls Efficacy Scale–International (FES-I) with that of the Berg Balance Scale (BBS), Dynamic Gait Index (DGI), Functional Reach Test (FRT), and Timed “Up & Go” Test (TUG) for predicting recurrent falls in people with PD and (2) to explore the ability of combinations of up to 3 tests to predict recurrent falls.

Design This was a prospective cohort study involving 225 people with PD.

Methods Participants were assessed with the ABC, FES-I, BBS, FRT, TUG, and DGI. Participants who reported 2 or more falls in the 12-month follow-up period were classified as recurrent fallers. Areas under the receiver operating characteristic curves were determined, and the Akaike information criterion was used to select the best predictive model.

Results Eighty-four participants (37.3%) were classified as recurrent fallers. Areas under the receiver operating characteristic curves for the ABC, FES-I, TUG, FRT, DGI, and BBS were 0.73, 0.74, 0.72, 0.74, 0.76, and 0.79, respectively. Two-test models provided additional discriminating ability compared with individual measures and had Akaike information criterion values similar to those of 3-test models, particularly the combination of the BBS with the FES-I.

Limitations The lack of an external validation sample was a limitation of this study.

Conclusions The ABC and FES-I demonstrated moderate accuracy in predicting recurrent falls and a predictive ability similar to that of performance-based balance measures, especially the FRT and the TUG. Two-test models showed performance similar to that of 3-test models, suggesting that a combination of 2 measures may improve the ability to predict recurrent falls in people with PD. Specifically, the combination of the BBS with the FES-I may be considered.

Footnotes

  • All authors provided concept/idea/research design. Ms Almeida provided writing. Ms Almeida, Dr Valenca, and Ms Negreiros provided data collection. Ms Almeida and Dr Oliveira-Filho provided data analysis. Ms Almeida, Dr Valenca, Dr Pinto, and Dr Oliveira-Filho provided project management. Dr Valenca and Ms Negreiros provided participants and facilities/equipment. Dr Valenca, Ms Negreiros, Dr Pinto, and Dr Oliveira-Filho provided consultation (including review of manuscript before submission). The authors thank Antônio Cunha Porto Maia for his statistical consultations.

  • This study was approved by the Comitê de Ética em Pesquisa da Secretaria da Saúde do Estado da Bahia, Escola Estadual de Saúde Pública, Salvador, Bahia, Brazil.

  • Received March 20, 2015.
  • Accepted January 17, 2016.
  • © 2016 American Physical Therapy Association
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Vol 96 Issue 7 Table of Contents
Physical Therapy: 96 (7)

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Comparison of Self-report and Performance-Based Balance Measures for Predicting Recurrent Falls in People With Parkinson Disease: Cohort Study
Lorena R.S. Almeida, Guilherme T. Valenca, Nádja N. Negreiros, Elen B. Pinto, Jamary Oliveira-Filho
Physical Therapy Jul 2016, 96 (7) 1074-1084; DOI: 10.2522/ptj.20150168

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Comparison of Self-report and Performance-Based Balance Measures for Predicting Recurrent Falls in People With Parkinson Disease: Cohort Study
Lorena R.S. Almeida, Guilherme T. Valenca, Nádja N. Negreiros, Elen B. Pinto, Jamary Oliveira-Filho
Physical Therapy Jul 2016, 96 (7) 1074-1084; DOI: 10.2522/ptj.20150168
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  • Reliability and Validity of Force Platform Measures of Balance Impairment in Individuals With Parkinson Disease
  • Predictors of Reduced Frequency of Physical Activity 3 Months After Injury: Findings From the Prospective Outcomes of Injury Study
  • Effects of Locomotor Exercise Intensity on Gait Performance in Individuals With Incomplete Spinal Cord Injury
Show more Measurement

Subjects

  • Examination/Evaluation
    • Tests and Measurements
  • Geriatrics
    • Falls and Falls Prevention
  • Neurology/Neuromuscular System
    • Parkinson Disease and Parkinsonian Disorders
    • Balance

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