Predicting Falls in Parkinson Disease: What Is the Value of Instrumented Testing in OFF Medication State?
Typ dokumentu
článek v časopisejournal article
Peer-reviewed
publishedVersion
Autor
Hoskovcová M.
Dušek P.
Sieger T.
Brožová H.
Zárubová K.
Bezdíček O.
Šprdlík O.
Jech R.
Štochl J.
Roth J.
Růžička E.
Práva
openAccessMetadata
Zobrazit celý záznamAbstrakt
Background
Falls are a common complication of advancing Parkinson's disease (PD). Although numer-
ous 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 bal-
ance 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.
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Kolekce
- Publikační činnost ČVUT [1378]