A Self‐Reported Clinical Tool Predicts Falls in People with Parkinson's Disease

Abstract

Background A 3‐step clinical prediction tool including falling in the previous year, freezing of gait in the past month and self‐selected gait speed <1.1 m/s has shown high accuracy in predicting falls in people with Parkinson's disease (PD). The accuracy of this tool when including only self‐report measures is yet to be determined. Objectives To validate the 3‐step prediction tool using only self‐report measures (3‐step self‐reported prediction tool), and to externally validate the 3‐step clinical prediction tool. Methods The clinical tool was used with 137 individuals with PD. Participants also answered a question about self‐reported gait speed, enabling scoring of the self‐reported tool, and were followed‐up for 6 months. An intraclass correlation coefficient (ICC2,1) was calculated to evaluate test–retest reliability of the 3‐step self‐reported prediction tool. Multivariate logistic regression models were used to evaluate the performance of both tools and their discriminative ability was determined using the area under the curve (AUC). Results Forty‐two participants (31%) reported ≥1 fall during follow‐up. The 3‐step self‐reported tool had an ICC2,1 of 0.991 (95% CI 0.971–0.997; P < 0.001) and AUC = 0.68; 95% CI 0.59–0.77, while the 3‐step clinical tool had an AUC = 0.69; 95% CI 0.60–0.78. Conclusions The 3‐step self‐reported prediction tool showed excellent test–retest reliability and was validated with acceptable accuracy in predicting falls in the next 6 months. The 3‐step clinical prediction tool was externally validated with similar accuracy. The 3‐step self‐reported prediction tool may be useful to identify people with PD at risk of falls in e/tele‐health settings.

Primary care for people with Parkinson's disease in Brazil: A referral flowchart based on risk of falls

“…Scales as Functional Gait Assessment ( 37 , 43 ) and Mini-Balance Evaluation Systems Test ( 44 ) are well structured but are lengthy and challenging to be applied by the primary health care network health professional who is unlikely to be a physiotherapist. An alternative is the 3-step fall prediction test, which assesses falls in the past year (Yes/No), freezing of gait in the past month (Yes/No), and comfortable gait speed (Yes/No) ( Table 1 ) ( 45 – 47 ).…”

“…The 3-step-fall-prediction test is objective and accessible to daily use, and it is validated for people with PD ( 46 , 47 ). It determines the probability of falling in the next 6 months and rates it as a low (17%), moderate (51%), or high (85%) risk of falls, based on the weighted sum of scores for the 3 questions.…”

“…The 3-step-fall prediction test has been externally validated in 171 PD people showing accuracy to discriminate fallers from non-fallers (AUC = 0.83; 95% CI 0.76–0.89) ( 46 ). The test has recently been administered using a self-report measure for gait speed with similar accuracy to the original 3-step clinical prediction tool ( 47 ). The self-reported 3-step-fall prediction test may be useful to identify people with PD at risk of falls in e/tele-health settings ( 47 ), or to use in HC with no space to test for gait speed and then referral to other services accordingly.…”

“…The following tables must be used within the referral flowchart. The Table 2 is a 3-step-fall-prediction test ( 46 , 47 ). This test is crucial for performing the flowchart.…”

“…Mov Disord. 28:655–62; ( 47 ) Almeida RSA, Piemonte MEP, Cavalcanti HM, Canning CG, Paul SS (2021) A self-reported clinical tool predicts falls in people with Parkinson's Disease. Mov Disord.…”