M. Hoskovcová, P. Dušek, T. Sieger, et al.
Predicting Falls in Parkinson Disease: What Is the Value of Instrumented Testing
in OFF Medication State?
Background: Falls are a common complication of advancing Parkinson's disease
(PD). Although numerous risk factors are known, reliable predictors of future
falls are still lacking. The objective of this prospective study was to
investigate clinical and instrumented tests of balance and gait in both OFF and
ON medication states and to verify their utility in the prediction of future
falls in PD patients.
Methods: Forty-five patients with idiopathic PD were examined in defined OFF and
ON medication states within one examination day including PD-specific clinical
tests, instrumented Timed Up and Go test (iTUG) and computerized dynamic
posturography. The same gait and balance tests were performed in 22 control
subjects of comparable age and sex. Participants were then followed-up for 6
months using monthly fall diaries and phone calls.
Results: During the follow-up period, 27/45 PD patients and 4/22 control
subjects fell one or more times. Previous falls, fear of falling, more severe
motor impairment in the OFF state, higher PD stage, more pronounced depressive
symptoms, higher daily levodopa dose and stride time variability in the OFF
state were significant risk factors for future falls in PD patients. Increased
stride time variability in the OFF state in combination with faster walking
cadence appears to be the most significant predictor of future falls, superior
to clinical predictors.
Conclusion: Incorporating instrumented gait measures into the baseline
assessment battery as well as accounting for both OFF and ON medication states
might improve future fall prediction in PD patients. However, instrumented
testing in the OFF state is not routinely performed in clinical practice and has
not been used in the development of fall prevention programs in PD. New
assessment methods for daylong monitoring of gait, balance and falls are thus
required to more effectively address the risk of falling in PD patients.