Department of Health Sciences, Lund University, Box 157, Lund SE-221 00, Sweden.
BMC Neurol. 2014 Jan 24;14:19. doi: 10.1186/1471-2377-14-19.
This study aimed to comprehensibly investigate potential contributing factors to fear of falling (FOF) among people with idiopathic Parkinson's disease (PD).
The study included 104 people with PD. Mean (SD) age and PD-duration were 68 (9.4) and 5 (4.2) years, respectively, and the participants' PD-symptoms were relatively mild. FOF (the dependent variable) was investigated with the Swedish version of the Falls Efficacy Scale, i.e. FES(S). The first multiple linear regression model replicated a previous study and independent variables targeted: walking difficulties in daily life; freezing of gait; dyskinesia; fatigue; need of help in daily activities; age; PD-duration; history of falls/near falls and pain. Model II included also the following clinically assessed variables: motor symptoms, cognitive functions, gait speed, dual-task difficulties and functional balance performance as well as reactive postural responses.
Both regression models showed that the strongest contributing factor to FOF was walking difficulties, i.e. explaining 60% and 64% of the variance in FOF-scores, respectively. Other significant independent variables in both models were needing help from others in daily activities and fatigue. Functional balance was the only clinical variable contributing additional significant information to model I, increasing the explained variance from 66% to 73%.
The results imply that one should primarily target walking difficulties in daily life in order to reduce FOF in people mildly affected by PD. This finding applies even when considering a broad variety of aspects not previously considered in PD-studies targeting FOF. Functional balance performance, dependence in daily activities, and fatigue were also independently associated with FOF, but to a lesser extent. Longitudinal studies are warranted to gain an increased understanding of predictors of FOF in PD and who is at risk of developing a FOF.
本研究旨在全面调查特发性帕金森病（PD）患者跌倒恐惧（FOF）的潜在影响因素。
研究纳入了 104 名 PD 患者。患者的平均（标准差）年龄和 PD 病程分别为 68（9.4）岁和 5（4.2）年，PD 症状相对较轻。FOF（因变量）采用瑞典版跌倒效能量表（FES(S)）进行评估。第一个多元线性回归模型复制了先前的研究，独立变量包括：日常生活中的行走困难；冻结步态；运动障碍；疲劳；日常生活活动需要帮助；年龄；PD 病程；跌倒/接近跌倒史和疼痛史。模型二还包括以下临床评估变量：运动症状、认知功能、步态速度、双重任务困难和功能性平衡表现以及反应性姿势反应。
两个回归模型均显示，导致 FOF 的最强因素是行走困难，分别解释了 FOF 评分的 60%和 64%。两个模型中其他显著的独立变量还有日常生活中需要他人帮助和疲劳。功能性平衡是唯一对模型 I 有显著附加信息贡献的临床变量，将解释的方差从 66%增加到 73%。
结果表明，为了降低轻度 PD 患者的 FOF，应主要针对日常生活中的行走困难。即使考虑到以前针对 FOF 的 PD 研究中未考虑的各种因素，这一发现仍然适用。功能性平衡表现、日常生活活动依赖和疲劳也与 FOF 独立相关，但程度较轻。需要进行纵向研究，以更深入地了解 PD 患者 FOF 的预测因素以及哪些人有 FOF 风险。
