Affiliations: Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands and Department of Neurology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands | Department of Clinical Neurosciences, Institute of Neurology [Royal Free Campus], University College, London, UK | Sobell Department of Neurophysiology, Institute of Neurology, Queen Square, London, UK | Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands | Department of Neurology, Radboud University Nijmegen Medical Centre, Donders Centre for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
Note:  Correspondence to: Prof Bastiaan R. Bloem, MD, PhD, Parkinson Center Nijmegen (ParC), Department of Neurology (935), Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands. Tel.: +31 24 3615202 (secretary); Fax: +31 24 3541122; E-mail: [email protected]
Abstract: 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.
Keywords: Parkinson disease, accidental falls, quality of life, postural balance