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Affiliation
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R. Galvin, PT, PhD, Physiotherapy Department, Royal College of Surgeons. |
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Abstract
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BACKGROUND: Falls are a common and disabling feature of Parkinson's disease (PD). Early identification of patients at greatest risk is a key goal of physiotherapy assessment. The 'Timed up and Go' test (TUG) is a frequently used mobility assessment tool, which demonstrates moderate sensitivity and specificity in identifying falls risk.
OBJECTIVE: To investigate whether adding a dual task (cognitive or manual) to the TUG increases the test's utility to identify risk of falls in persons with PD.
DESIGN: A retrospective cohort study of persons with PD (n=36).
METHODS: Participants were compared on the basis of self-reported falls exposure in the previous 6 months (fallers vs. non-fallers). The time taken to complete the TUG, TUG-cognitive and TUG-manual was measured in both groups. Between-group differences were calculated using Mann-Whitney U tests. The discriminative performance of the test was examined at different cut-off points and estimates of sensitivity and specificity were based on receiver operator characteristic plots.
RESULTS: Fallers took significantly longer than non-fallers (n=19) to complete the TUG test under all three conditions (TUG p =0.005, TUG-cognitive p =0.001, TUG-manual p =0.005). The TUG-cognitive demonstrated optimal discriminative performance (AUCROC=0.81, 95% CI 0.64-0.92) at a cut-off of 14.7 seconds. The TUG-cognitive is more likely to correctly classify those at low risk (LR+=2.9) (<14.7 seconds) with higher estimates of sensitivity (0.76, 95% CI 0.52-0.90) than specificity (0.73, 95%CI 0.51-0.88) at this threshold (LR-=0.32). LIMITATIONS: Retrospective classification of fallers and non-fallers was used.
CONCLUSIONS: Addition of a cognitive dual task to the TUG enhances identification of falls risk for patients with PD. The TUG-cognitive test should be considered as a component of a multifaceted falls risk assessment in PD.
Language: en |