Fear of falling in persons with Parkinson's disease

Stina Jonasson

Research output: ThesisDoctoral Thesis (compilation)

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Fear of falling (FOF) is common in persons with Parkinson’s disease (PD) and may have large consequences in daily life, causing a sedentary lifestyle, social isolation and reduced quality of life. FOF is therefore an important aspect to consider for researchers as well as clinicians and the rehabilitation team. Adequate and high quality rating scales are needed to be able to accurately assess FOF and thereby monitor how it changes over time. To facilitate the process of choosing a suitable rating scale, the conceptual understanding of commonly used FOF rating scales needs to be improved and further knowledge of their psychometric properties is needed. In order to provide optimal treatment, care and rehabilitation for people with PD, comprehensive studies that explore explanatory factors of FOF are needed. Moreover, there is a need for a deeper and richer understanding of FOF as a phenomenon. As yet, no study has explored how persons with PD experience FOF. The overarching aim of this thesis was to increase the knowledge of how FOF can be assessed in persons with PD, as well as to expand and deepen the understanding of FOF in persons with PD in relation to explanatory factors and the persons’ own experiences. Four different FOF rating scales were analyzed in the first two studies. These were the Swedish version of the Falls Efficacy Scale (FES(S)), Falls Efficacy Scale-International (FES-I), Activities-specific Balance Confidence scale (ABC) and modified Survey of Activities and Fear of Falling in the Elderly (mSAFFE). The first study was a linking study in which the four FOF rating scales were linked to the International Classification of Functioning, Disability and Health (ICF). This study did not include any empirical data. The second study was a psychometric study, in which the four FOF rating scales were administered twice (test and retest) as a postal survey. This study included 102 participants (median age 74 years, median PD duration 5 years). The third study was a multivariable regression study, in which explanatory factors of FOF (conceptualized as concerns about falling) were explored, taking both PD-related disabilities, personal and environmental factors into consideration. This study included 241 participants (median age 70 years, median PD duration 8 years). The fourth study was a qualitative interview study which explored how persons with PD and FOF experienced their FOF. Interviews were conducted with twelve persons with PD (median age 70 years, median PD duration 9 years). The linking study revealed that the vast majority of the items in the four FOF rating scales emphasized the ICF component of activities and participation. All four scales predominately focused on the chapter of mobility, in particular the ABC, whereas the other scales were more diverse. The psychometric comparison revealed that ABC had markedly worse data completeness than the other scales, and FES(S) and ABC had more outliers when comparing the two test occasions. All four scales showed acceptable reliability, but FES-I was the only scale with a test-retest reliability that reached the suggested level for usage in individual comparisons. Several factors were significant (p < 0.05) explanatory factors of concerns about falling. Walking difficulties in everyday life were the strongest explanatory factor, followed by orthostatism, motor symptoms, age and fatigue. FOF affected the lives of the persons with PD and FOF in several ways. It was experienced as a disturbance in everyday life. FOF was a varying experience and different strategies were adopted to handle FOF. In conclusion, FES-I or mSAFFE are suggested for assessing FOF in people with PD. However, scale selection should consider the aspects of FOF that one wishes to address. Moreover, the results indicate that interventions targeting FOF need to be individually tailored for persons with PD and focus on several aspects, e.g., PD-related symptoms and disabilities, activities and environmental factors.
Original languageEnglish
  • Lexell, Jan, Supervisor
  • Nilsson, Maria H, Supervisor
Award date2016 Nov 4
Place of PublicationLund
ISBN (Print)978-91-7619-331-0
Publication statusPublished - 2016

Bibliographical note

Defence details
Date: 2016-11-04
Time: 09:00
Place: Health Sciences Centre, Baravägen 3 i Lund.
External reviewer(s)
Name: Hellström, Karin
Title: docent
Affiliation: Uppsala University
ISSN: 1652-8220
Lund University, Faculty of Medicine Doctoral Dissertation Series 2016:105


  • Activity avoidance
  • Balance confidence
  • Concerns about falling
  • Fall-related self-efficacy
  • International Classification of Functioning, Disability and Health (ICF)
  • Linking study
  • Psychometrics
  • Qualitative research
  • Regression analysis
  • Reliability
  • Self-reported rating scale


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