Factors associated with fear of falling in people with Parkinson’s disease

Abstract

BackgroundThis study aimed to comprehensibly investigate potential contributing factors to fear of falling (FOF) among people with idiopathic Parkinson’s disease (PD).MethodsThe study included 104 people with PD. Mean (SD) age and PD-duration were 68 (9.4) and 5 (4.2) years, respectively, and the participants’ PD-symptoms were relatively mild. FOF (the dependent variable) was investigated with the Swedish version of the Falls Efficacy Scale, i.e. FES(S). The first multiple linear regression model replicated a previous study and independent variables targeted: walking difficulties in daily life; freezing of gait; dyskinesia; fatigue; need of help in daily activities; age; PD-duration; history of falls/near falls and pain. Model II included also the following clinically assessed variables: motor symptoms, cognitive functions, gait speed, dual-task difficulties and functional balance performance as well as reactive postural responses.ResultsBoth regression models showed that the strongest contributing factor to FOF was walking difficulties, i.e. explaining 60% and 64% of the variance in FOF-scores, respectively. Other significant independent variables in both models were needing help from others in daily activities and fatigue. Functional balance was the only clinical variable contributing additional significant information to model I, increasing the explained variance from 66% to 73%.ConclusionsThe results imply that one should primarily target walking difficulties in daily life in order to reduce FOF in people mildly affected by PD. This finding applies even when considering a broad variety of aspects not previously considered in PD-studies targeting FOF. Functional balance performance, dependence in daily activities, and fatigue were also independently associated with FOF, but to a lesser extent. Longitudinal studies are warranted to gain an increased understanding of predictors of FOF in PD and who is at risk of developing a FOF.

Concerns About Falling in Parkinson’s Disease: Associations with Disabilities and Personal and Environmental Factors

“…The importance of walking difficulties corroborates previous studies that targeted contributing factors to fall-related self-efficacy in people with PD [10,12]; walking difficulties alone explained then 60-68% of the variation in scores. Another PD study that targeted balance confidence [21] also identified walking difficulties to be of importance.…”

“…Several PD studies have investigated associated factors to FOF by using multivariate regression analyses [10,12,[19][20][21]. However, two of these studies were based on data collected by means of postal surveys and therefore lacked clinical data [12,19] and three studies included few (n = 4-6) potential independent variables [19][20][21], resulting in non-comprehensive analyses of contributors to FOF.…”

“…Prior multivariate PD studies on FOF have mainly focused on disabilities related to PD (such as difficulties in walking and activities of daily living) [10,12,[19][20][21]. Less is known about the associations between FOF and personal and environmental factors, as defined by the International Classification of Functioning, Disability and Health (ICF) [22].…”

Cognitive predictors of balance in Parkinson’s disease

“…As to the anteroposterior displacement, the cognitive variables included explained 23% of the variability of the anteroposterior displacement, increasing to 34% when the individual and clinical variables were added. A recent study (Lindholm et al 2014) has shown that cognitive impairments, particularly EFs, are closely related to motor symptoms, especially with postural instability. Hence, the results of the correlations found showed that at least one cognitive test was correlated with balance.…”

“…Recent studies have shown that impairments in EFs are closely related to motor symptoms, particularly with postural instability (Lindholm et al 2014). This may be due to the important role of these functions in anticipation, planning, and coordination (McCloskey and Perkins 2012).…”