Fear of falling, falls and near falls in Parkinson’s disease

Research output: ThesisDoctoral Thesis (compilation)

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Abstract

ABSTRACT
AIM: The overall aim of this longitudinal PhD project was to gain increased knowledge about factors associated with fear of falling (FOF) falls and near falls, as well as to contribute to improved clinical fall prediction for people
with mild Parkinson’s disease (PD).
METHODS: People diagnosed with PD and receiving care at the university hospital outpatient neurology clinic were assessed during the “on” phase using a broad range of rating scales and clinical tests targeting balance and gait problems as well as motor and non-motor symptoms. The participants then registered all prospective falls and near falls for six months by using a diary.
RESULTS: Paper I identified everyday walking difficulties as the strongest factor independently associated with FOF, followed by independence in daily activities, functional balance, and fatigue. Paper II identified FOF to be the strongest factor independently associated with prospective falls and/or near falls, followed by history of near falls, and retropulsion during an unexpected shoulder pull. Paper III showed that the discriminate ability of a recently suggested clinical 3-Step Falls Prediction Model (3-step model) is acceptable and better than that of single predictors. Extended analyses showed that a new model for prediction of falls and/or near falls (including history of near falls, tandem gait and retropulsion) had better discriminant ability than the 3-step model. Paper IV found that different standardizations of the 10-Meter Walk Test (10MWT) for measuring gait speed yielded very similar results, including cut-off scores for future falls, suggesting that the clinical conduct of 10MWT can be simplified.
CONCLUSIONS: Everyday walking difficulties should be a primary target when attempting to reduce FOF in mild PD, and balance training should focus on self-generated perturbations caused by everyday activities rather
than external perturbations. Moreover, FOF and asking about prior near falls seem to be important issues for prediction of falls and near falls early in the disease course. The 3-step model can be recommended as a clinical
prediction tool but a new model may be considered a promising alternative. Clinical gait speed measurement by the 10MWT can be simplified by not using acceleration distance or repeated trials in mild PD.
Original languageEnglish
QualificationDoctor
Supervisors/Advisors
  • Hagell, Peter, Supervisor
  • Nilsson, Maria H, Supervisor
  • Hansson, Oskar, Supervisor
Award date2017 Mar 31
Place of PublicationLund
Publisher
ISBN (Print)978-91-7619-420-1
Publication statusPublished - 2017

Bibliographical note

Defence details
Date: 2017-03-31
Time: 09:00
Place: Kvinnoklinikens aula, Skånes Universitetssjukhus i Malmö
External reviewer(s)
Name: Nyholm, Dag
Title: docent
Affiliation: Uppsala Universitet
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ISSN: 1652-8220
Lund University, Faculty of Medicine Doctoral Dissertation Series 2017:39

Subject classification (UKÄ)

  • Medical and Health Sciences

Keywords

  • Parkinson’s disease, Fear of falling, Self-Efficacy, Falls, Near falls, Walking, Balance, Prediction, Validation studies, Rehabilitation, Prevention

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