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Comparison of Self-report and Performance-Based Balance Measures for Predicting Recurrent Falls in People With
Lorena R S Almeida1, Guilherme T Valenca2, Nádja N Negreiros3
1L.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. lorenasantos@gmail.com.
Background:
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.
Objective:
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.
Design:
This was a prospective cohort study involving 225 people with PD.
Methods:
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.
Results:
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.
Limitations:
The lack of an external validation sample was a limitation of this study.
Conclusions:
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.
