TY  - JOUR
PY  - 2017//
TI  - Predictors of recurrent falls in people with Parkinson's disease and proposal for a predictive tool
JO  - Journal of Parkinson's disease
A1  - Almeida, Lorena R. S.
A1  - Valença, Guilherme T.
A1  - Negreiros, Nádja N.
A1  - Pinto, Elen B.
A1  - Oliveira-Filho, Jamary
SP  - 313
EP  - 324
VL  - 7
IS  - 2
N2  - BACKGROUND: Falls are a debilitating problem for people with Parkinson's disease (PD). <br><br>OBJECTIVES: To compare clinical and functional characteristics of non-fallers, single and recurrent fallers (≥2 falls); to determine predictors of time to second fall; and to develop a predictive tool for identifying people with PD at different categories of falls risk. <br><br>METHODS: Participants (n = 229) were assessed by disease-specific, self-report and balance measures and followed up for 12 months. Area under the receiver operating characteristic curves (AUC), Kaplan-Meier curves and log-rank test were performed. Selected predictors with p < 0.10 in univariate analysis were chosen to be entered into the Cox regression model. <br><br>RESULTS: Eighty-four (37%) participants had ≥2 falls during the follow-up. Recurrent fallers significantly differed from single fallers. The final Cox model included history of ≥2 falls in the past year (Hazard ratio [HR] = 3.94; 95% confidence interval [CI] 2.26-6.86), motor fluctuations (HR = 1.91; 95% CI 1.12-3.26), UPDRS activities of daily living (ADL) (HR = 1.10 per 1 point increase; 95% CI 1.06-1.14) and levodopa equivalent dose (LED) (HR = 1.09 per 100 mg increase; 95% CI 1.02-1.16). A 3-predictor tool included history of ≥2 falls in the past year, motor fluctuations and UPDRS AD >12 points (AUC = 0.84; 95% CI 0.78-0.90). By adding LE >700 mg/day and Berg balance scale ≤49 points, a 5-predictor tool was developed (AUC = 0.86; 95% CI 0.81-0.92). <br><br>CONCLUSIONS: Two predictive tools with moderate-to-high accuracy may identify people with PD at low, medium and high risk of falling recurrently within the next year. However, future studies to address external validation are required.<p />  <p>Language: en</p>
LA  - en
SN  - 1877-7171
UR  - http://dx.doi.org/10.3233/JPD-160934
ID  - ref1
ER  -