Department of Clinical Sciences, Clinical Memory Research Unit, Lund University, 205 02 Malmö, Sweden.
Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, 205 02 Malmö, Sweden.
Int J Environ Res Public Health. 2021 Nov 24;18(23):12325. doi: 10.3390/ijerph182312325.
People with Parkinson's disease (PwPD) have an increased risk for falls and near falls. They have particular difficulties with maintaining balance against an external perturbation, and several retropulsion tests exist. The Unified PD Rating Scale item 30 (UPDRS30) is the most common, involving an expected shoulder pull. Others recommend using an unexpected shoulder pull, e.g., the Nutt Retropulsion Test (NRT). We aimed to evaluate the clinical usefulness of these tests for detecting future fallers. By using two different golden standards related to self-reported prospective falls and near falls over 6 months following two different time points with 3.5 years between, we estimated sensitivity/specificity, Youden index, predictive values, and likelihood ratios for each test. The different time points yielded a different prevalence of falls and near falls, as well as different predictive values. When comparing the performance of the NRT and UPDRS30 for detecting future fallers, we found that the NRT consistently performed better than UPDRS30. However, neither test exhibited optimal performance in terms of predictive values and associated likelihood ratios. Our findings speak against using either of these tests as a single assessment for this purpose and support previous recommendations of using a multifactorial approach when targeting balance problems in PwPD.
帕金森病患者(PwPD)有较高的跌倒和近乎跌倒风险。他们在应对外部干扰时维持平衡特别困难,目前有几种后退测试。统一帕金森病评定量表第 30 项(UPDRS30)是最常用的,涉及到预期的肩部牵拉。其他研究建议使用意外的肩部牵拉,例如 Nutt 后退测试(NRT)。我们旨在评估这些测试在检测未来跌倒者方面的临床有用性。通过使用两个不同的黄金标准,分别与自我报告的前瞻性跌倒和接近跌倒有关,这两个标准在 3.5 年的时间间隔内涉及两个不同的时间点,我们评估了每个测试的敏感性/特异性、Youden 指数、预测值和似然比。不同的时间点导致跌倒和接近跌倒的发生率不同,预测值也不同。当比较 NRT 和 UPDRS30 检测未来跌倒者的性能时,我们发现 NRT 的表现始终优于 UPDRS30。然而,这两种测试在预测值和相关似然比方面都没有表现出最佳性能。我们的研究结果反对将这些测试中的任何一种作为单一评估用于此目的,并支持之前的建议,即在针对 PwPD 的平衡问题时使用多因素方法。