Almeida Lorena R S, Valenca Guilherme T, Negreiros Nádja N, Pinto Elen B, Oliveira-Filho Jamary
L.R.S. Almeida, PT, MSc, Movement Disorders and Parkinson's Disease Clinic, Roberto Santos General Hospital/SESAB, Rua Direta do Saboeiro, s/n-Cabula, 41180-780, Salvador, Bahia, Brazil; Postgraduate Program in Health Sciences, School of Medicine, Federal University of Bahia, Salvador, Bahia, Brazil; and Behavior and Motor Learning Research Group, Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil.
G.T. Valenca, MD, PhD, Movement Disorders and Parkinson's Disease Clinic, Roberto Santos General Hospital/SESAB, and Health Sciences Center, Federal University of Reconcavo of Bahia, Santo Antônio de Jesus, Bahia, Brazil.
Phys Ther. 2016 Jul;96(7):1074-84. doi: 10.2522/ptj.20150168. Epub 2016 Jan 28.
Balance confidence and fear of falling are factors associated with recurrent falls in people with Parkinson disease (PD). However, the accuracy for predicting falls on the basis of self-report measures has not been widely investigated.
The study objectives were: (1) to compare the accuracy of the Activities-specific Balance Confidence Scale (ABC) and the Falls Efficacy Scale-International (FES-I) with that of the Berg Balance Scale (BBS), Dynamic Gait Index (DGI), Functional Reach Test (FRT), and Timed "Up & Go" Test (TUG) for predicting recurrent falls in people with PD and (2) to explore the ability of combinations of up to 3 tests to predict recurrent falls.
This was a prospective cohort study involving 225 people with PD.
Participants were assessed with the ABC, FES-I, BBS, FRT, TUG, and DGI. Participants who reported 2 or more falls in the 12-month follow-up period were classified as recurrent fallers. Areas under the receiver operating characteristic curves were determined, and the Akaike information criterion was used to select the best predictive model.
Eighty-four participants (37.3%) were classified as recurrent fallers. Areas under the receiver operating characteristic curves for the ABC, FES-I, TUG, FRT, DGI, and BBS were 0.73, 0.74, 0.72, 0.74, 0.76, and 0.79, respectively. Two-test models provided additional discriminating ability compared with individual measures and had Akaike information criterion values similar to those of 3-test models, particularly the combination of the BBS with the FES-I.
The lack of an external validation sample was a limitation of this study.
The ABC and FES-I demonstrated moderate accuracy in predicting recurrent falls and a predictive ability similar to that of performance-based balance measures, especially the FRT and the TUG. Two-test models showed performance similar to that of 3-test models, suggesting that a combination of 2 measures may improve the ability to predict recurrent falls in people with PD. Specifically, the combination of the BBS with the FES-I may be considered.
平衡信心和跌倒恐惧是与帕金森病（PD）患者反复跌倒相关的因素。然而，基于自我报告测量来预测跌倒的准确性尚未得到广泛研究。
本研究的目的是：（1）比较特定活动平衡信心量表（ABC）、国际跌倒效能量表（FES-I）与伯格平衡量表（BBS）、动态步态指数（DGI）、功能性伸展测试（FRT）和定时起立行走测试（TUG）预测PD患者反复跌倒的准确性；（2）探索最多3项测试组合预测反复跌倒的能力。
这是一项涉及225名PD患者的前瞻性队列研究。
对参与者进行ABC、FES-I、BBS、FRT、TUG和DGI评估。在12个月随访期内报告有2次或更多次跌倒的参与者被归类为反复跌倒者。确定受试者操作特征曲线下的面积，并使用赤池信息准则选择最佳预测模型。
84名参与者（37.3%）被归类为反复跌倒者。ABC、FES-I、TUG、FRT、DGI和BBS的受试者操作特征曲线下面积分别为0.73、0.74、0.72、0.74、0.76和0.79。与单项测量相比，两项测试模型具有额外的鉴别能力，且赤池信息准则值与三项测试模型相似，尤其是BBS与FES-I的组合。
缺乏外部验证样本是本研究的一个局限性。
ABC和FES-I在预测反复跌倒方面显示出中等准确性，且预测能力与基于表现的平衡测量相似，尤其是FRT和TUG。两项测试模型的表现与三项测试模型相似，这表明两项测量的组合可能会提高预测PD患者反复跌倒的能力。具体而言，可以考虑BBS与FES-I的组合。
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