Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands and Department of Neurology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands.
J Parkinsons Dis. 2013 Jan 1;3(3):409-13. doi: 10.3233/JPD-120113.
Postural instability, recurrent falls and fear of falling are common in advanced Parkinson's disease (PD). We examined the impact of fall frequency, fear of falling, balance confidence and objectively measured balance impairment (using Tinetti's Mobility Index) on health-related quality of life (HrQoL) in PD. In 74 subjects HrQoL was assessed using the 39-item Parkinson's disease Quality of Life Questionnaire [PDQ-39]. Patients were interviewed using a validated falls questionnaire, addressing fall history, consequences of falls and fear of falling. Neurological examination included Hoehn and Yahr scale, the Unified Parkinson's disease Rating Scale and Tinetti's Mobility Index. Disease severity, age and gender explained 43% of the differences in HrQoL across patients (R2 = 0.43). The combination of these factors and each of the factors fear of falling, balance confidence and fall frequency lead to 55%, 50% and 45% of explained variation, respectively. The standardised regression coefficients of these risk factors were 0.34 (fear of falling), 0.28 (balance confidence) and 0.13 (fall frequency). This suggests that fear of falling is a more important determinant of HrQoL than actual falling. These results emphasise the importance of addressing fear of falling in the clinical management of PD, and the need for development of strategies to reduce fear of falling in intervention programs.
姿势不稳、反复跌倒和恐摔是晚期帕金森病（PD）的常见症状。我们研究了跌倒频率、恐摔、平衡信心和客观测量的平衡障碍（使用 Tinetti 活动能力指数）对 PD 患者健康相关生活质量（HrQoL）的影响。在 74 名受试者中，使用 39 项帕金森病生活质量问卷 [PDQ-39] 评估了他们的生活质量。通过一份经过验证的跌倒问卷对患者进行访谈，内容包括跌倒史、跌倒后果和恐摔。神经学检查包括 Hoehn 和 Yahr 量表、统一帕金森病评定量表和 Tinetti 活动能力指数。疾病严重程度、年龄和性别解释了患者间 HrQoL 差异的 43%（R2 = 0.43）。这些因素的组合以及恐摔、平衡信心和跌倒频率这三个因素分别可以解释 55%、50%和 45%的变异。这些危险因素的标准化回归系数分别为 0.34（恐摔）、0.28（平衡信心）和 0.13（跌倒频率）。这表明恐摔比实际跌倒更能决定 HrQoL。这些结果强调了在 PD 临床管理中解决恐摔问题的重要性，以及在干预计划中需要制定减少恐摔的策略。
