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Prediction of Falls in Subjects Suffering From Parkinson Disease, Multiple Sclerosis, and Stroke

Published:November 01, 2017DOI:https://doi.org/10.1016/j.apmr.2017.10.009

      Abstract

      Objective

      To compare the risk of falls and fall predictors in patients with Parkinson disease (PD), multiple sclerosis (MS), and stroke using the same study design.

      Design

      Multicenter prospective cohort study.

      Setting

      Institutions for physical therapy and rehabilitation.

      Participants

      Patients (N=299) with PD (n=94), MS (n=111), and stroke (n=94) seen for rehabilitation.

      Interventions

      Not applicable.

      Main Outcome Measures

      Functional scales were applied to investigate balance, disability, daily performance, self-confidence with balance, and social integration. Patients were followed for 6 months. Telephone interviews were organized at 2, 4, and 6 months to record falls and fall-related injuries. Incidence ratios, Kaplan-Meier survival curves, and Cox proportional hazards models were used.

      Results

      Of the 299 patients enrolled, 259 had complete follow-up. One hundred and twenty-two patients (47.1%) fell at least once; 82 (31.7%) were recurrent fallers and 44 (17.0%) suffered injuries; and 16%, 32%, and 40% fell at 2, 4, and 6 months. Risk of falls was associated with disease type (PD, MS, and stroke in decreasing order) and confidence with balance (Activities-specific Balance Confidence [ABC] scale). Recurrent fallers were 7%, 15%, and 24% at 2, 4, and 6 months. The risk of recurrent falls was associated with disease type, high educational level, and ABC score. Injured fallers were 3%, 8%, and 12% at 2, 4, and 6 months. The only predictor of falls with injuries was disease type (PD).

      Conclusions

      PD, MS, and stroke carry a high risk of falls. Other predictors include perceived balance confidence and high educational level.

      Keywords

      List of abbreviations:

      ABC (Activities-specific Balance Confidence), BBS (Berg Balance Scale), CI (confidence interval), CIQ (Community Integration Questionnaire), DGI (Dynamic Gait Index), IADL (instrumental activities of daily living), IQR (interquartile range), MS (multiple sclerosis), PD (Parkinson disease)
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