Affiliations: [a] Movement Disorders and Parkinson’s Disease Clinic, Roberto Santos General Hospital, Salvador, BA, Brazil | [b] Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, BA, Brazil | [c] Clinical and Rehabilitation Sciences Research Group, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia | [d] The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
Correspondence to: Colleen Canning, Faculty of Health Sciences, The University of Sydney, P.O. Box 170, Lidcombe, New South Wales 1825, Australia. Tel.: +61 2 9351 9263; E-mail: [email protected]
Abstract: Background:Predictors of falls in people with Parkinson’s disease (PD) who have not previously fallen are yet to be identified. Objectives:We aimed to identify predictors of all falls and recurrent falls in people with PD who had not fallen in the previous year and to explore the timing of falls in a 12-month follow-up period. Methods:Participants with PD (n = 130) were assessed by disease-specific, self-report and balance measures. Falls were recorded prospectively for 12 months. Univariate and multivariate analyses were performed. Kaplan-Meier survival analysis was used to investigate time to falling. Results:Forty participants (31%) had ≥1 fall during follow-up and 21 (16%) had ≥2 falls. Disability, reduced balance confidence and greater concern about falling were associated with ≥1 fall in univariate analyses. Additionally, PD duration and severity, freezing of gait and impaired balance were associated with ≥2 falls (p < 0.05). Disability (Schwab and England scale, Odds Ratio [OR] = 0.56 per 10 points increase; 95% confidence interval [CI] 0.39–0.80; p = 0.002) was associated with ≥1 fall in the final multivariate model (area under the receiver operating characteristic curve [AUC] = 0.65; 95% CI 0.55–0.76; p = 0.005). Disability (Unified Parkinson’s Disease Rating Scale activities of daily living, OR = 1.20; 95% CI 1.07–1.34; p = 0.001) and levodopa equivalent dose (OR = 1.11 per 100 mg increase; 95% CI 0.95–1.30; p = 0.19) were associated with ≥2 falls in the final multivariate model (AUC = 0.72; 95% CI 0.60–0.84; p = 0.001). Recurrent fallers experienced their first fall earlier than single fallers (p < 0.05). Conclusions:Self-reported disability was the strongest single predictor of all falls and recurrent falls.
Keywords: Parkinson’s disease, accidental falls, risk factors, postural balance