Should One Measure Balance or Gait to Best Predict Falls among People with Parkinson Disease?

Abstract

Introduction. We aimed to determine whether gait velocity is as useful as a balance test, a self-report measure of freezing of gait (FOG), and/or a measure of motor symptom severity for predicting falls among people with Parkinson Disease (PD). Methods. Fifty-six individuals with idiopathic PD completed a baseline assessment consisting of these measures: (1) MDS-UPDRS III, (2) Mini-BESTest, (3) gait velocity (forward, backward, dual task, and fast), and (4) FOGQ. Retrospective fall history was collected at baseline and six months later. Participants were considered fallers if they had two or more falls in the surveillance period. Ability of the tests to discriminate between fallers and nonfallers was determined using ROC curves followed by pairwise statistical noninferiority comparisons (P=.05) of the area under the ROC curve (AUC) for each test. Results. At six months, 22% (n=21) of the sample were fallers. Fallers differed significantly from nonfallers on the MDS-UPDRS III, Mini-BESTest, backward gait velocity, and FOGQ. The Mini-BESTest had the highest AUC and was superior to all gait velocity measures at identifying fallers. Conclusion. A single measure of gait velocity, even in a challenging condition, may not be as effective as the Mini-BESTest in identifying fallers among people with PD.