Development and Validation of a Brief Fall Questionnaire (FALL-HD) for Patients with Huntington's Disease

Area of Science:

• Neuroscience
• Clinical Assessment
• Biomedical Engineering

Background:

• Huntington's disease (HD) is a genetic neurodegenerative disorder characterized by progressive motor, cognitive, and functional decline.
• Falls are a primary cause of nursing home placement in HD patients, highlighting a critical unmet clinical need.
• Validated instruments for assessing fall status and frequency in ambulatory HD patients are currently lacking.

Purpose of the Study:

• To develop and psychometrically evaluate a questionnaire for assessing fall status, including frequency, in ambulatory individuals with HD.
• To provide a reliable and valid screening tool for fall risk in the Huntington's disease population.

Main Methods:

• A concise, 3-item questionnaire (FALL-HD) was developed based on literature review and pilot testing.
• Psychometric properties, including test-retest reliability, internal consistency, and various forms of validity, were assessed in 107 HD gene-positive participants.
• Criterion validity was examined against established measures like the Unified Huntington's Disease Rating Scale (UHDRS) and measures of postural stability.

Main Results:

• The FALL-HD Questionnaire demonstrated strong reliability (test-retest r=0.85, Cronbach's alpha=0.71).
• Convergent validity was supported by significant correlations with UHDRS scores (motor, chorea, functional capacity) and Total Body Sway (TBS).
• Receiver Operating Characteristic (ROC) curve analysis indicated the FALL-HD (AUC=0.90) outperformed existing balance measures in fall assessment.

Conclusions:

• The FALL-HD Questionnaire is a brief, valid, and reliable screening instrument for fall status and frequency in ambulatory HD patients.
• This tool addresses the need for validated fall assessment in Huntington's disease.
• The FALL-HD can aid clinicians in identifying and managing fall risks in this population.