Systematic review for the prevention and management of falls and fear of falling in patients with Parkinson's disease

Liu, Wen-Yi; Tung, Tao‐Hsin; Zhang, Chencheng; Shi, Leiyu

doi:10.1002/brb3.2690

Cited by 14 publications

(13 citation statements)

References 168 publications

(283 reference statements)

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“…Gait speed in patients who had fallen was slower than in non-fallers [ 52 ]. Reduced gait speed in PD after falls as part of more cautious gait and FOF are significantly associated with previous falls [ 2 , 10 , 47 , 52 ]. A more cautious gait, which can also be observed in healthy older adults in general [ 53 ], is characterized by reduced gait speed, reduced step length, and lower toe clearance in order to be as “close as possible” in contact with the floor.…”

Section: Discussionmentioning

confidence: 99%

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Gait Characteristics Associated with Fear of Falling in Hospitalized People with Parkinson’s Disease

Uhlig

Prell

2023

Sensors

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Background: Fear of falling (FOF) is common in Parkinson’s disease (PD) and associated with distinct gait changes. Here, we aimed to answer, how quantitative gait assessment can improve our understanding of FOF-related gait in hospitalized geriatric patients with PD. Methods: In this cross-sectional study of 79 patients with advanced PD, FOF was assessed with the Falls Efficacy Scale International (FES-I), and spatiotemporal gait parameters were recorded with a mobile gait analysis system with inertial measurement units at each foot while normal walking. In addition, demographic parameters, disease-specific motor (MDS-revised version of the Unified Parkinson’s Disease Rating Scale, Hoehn & Yahr), and non-motor (Non-motor Symptoms Questionnaire, Montreal Cognitive Assessment) scores were assessed. Results: According to the FES-I, 22.5% reported low, 28.7% moderate, and 47.5% high concerns about falling. Most concerns were reported when walking on a slippery surface, on an uneven surface, or up or down a slope. In the final regression model, previous falls, more depressive symptoms, use of walking aids, presence of freezing of gait, and lower walking speed explained 42% of the FES-I variance. Conclusion: Our study suggests that FOF is closely related to gait changes in hospitalized PD patients. Therefore, FOF needs special attention in the rehabilitation of these patients, and targeting distinct gait parameters under varying walking conditions might be a promising part of a multimodal treatment program in PD patients with FOF. The effect of these targeted interventions should be investigated in future trials.

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Section: Discussionmentioning

confidence: 99%

“…Falls, and fear of falling (FOF), are common and serious problems in people with Parkinson’s disease (PD) [ 1 , 2 ]. FOF has been defined as ongoing concerns about falling, low fall-related self-efficacy, fearful anticipation of falling, and activity avoidance [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Gait Characteristics Associated with Fear of Falling in Hospitalized People with Parkinson’s Disease

Uhlig

Prell

2023

Sensors

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“…iluminação insuficiente, pisos e calçadas escorregadios ou com deformidades e comportamentos de risco (LIU et al, 2022). A prevenção é o elo mais importante no manejo das quedas, e ela se fundamenta nos fatores passíveis de modificação como os fatores extrínsecos (atentando-se para a iluminação, os calçados, os pisos etc.)…”

Section: Manejo De Quedasunclassified

Pesquisas Envolvendo Pacientes Com Doença De Parkinson No Brasil – Uma Revisão Integrativa

Da Silva Souza,

Gbur Hochuli,

Negro-Dellacqua

2023

RECIMA21

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A Doença de Parkinson (DP) é uma doença crônica que atinge cerca de 6,1 milhões de pessoas e que figura em primeiro lugar no ranking das afecções neurodegenerativas que mais crescem em quantidade de portadores no mundo (DORSEY et al, 2018). A DP, que é majoritariamente conhecida por seus sintomas motores, hoje possui um quadro clínico ampliado, com sintomas neuropsiquiátricos, autonômicos e sensoriais. Até o momento, o tratamento da DP é feito majoritariamente com levodopa (L-DOPA), que, no início, é eficaz para os sintomas motores. Entretanto, a terapia não interrompe a progressão da doença e com o tempo pode perder a eficácia, necessitando de ajustes e complementações com outros fármacos e terapias. Assim, o objetivo deste estudo é compilar as terapias para a Doença de Parkinson que atualmente estão sendo pesquisadas por testes clínicos no contexto brasileiro. Para tal, foi realizada uma revisão integrativa da literatura científica, tendo como base artigos disponibilizados nas seguintes plataformas: Scientific Eletronic Library Online – SCIELO, a U.S. National Library of Medicine (NLM) - PubMed e ScienceDirect. Visa-se, por meio disso, reunir informações úteis para o tratamento clínico mais amplo/holístico de pacientes com doença de Parkinson. Os estudos demonstraram o valor da estimulação cerebral profunda (ECP), da L-DOPA para além dos sintomas motores, dos exercícios e do manejo de quedas no tratamento da doença. Mesmo assim, esses resultados são estimulantes para que se continue pesquisando terapias alternativas para a DP.

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“…Additionally, the consequences of falls represent high costs to patients and healthcare services [ 4 ]. Due to these serious consequences, falls figure as a public health concern [ 1 , 5 ]. In this context, it is necessary to devote attention to falls management in PD, including the identification of PD-specific markers for risk of falling [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…Falls have a multifactorial etiology in PD and several risk factors have been identified [ 5 , 8 , 9 , 10 ]. Clinical aspects such as fall history, more severe/advanced disease, greater levodopa dosage, impaired postural control and cognitive deficits have been shown to increase the risk of falling in PD [ 8 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Combination of Clinical and Gait Measures to Classify Fallers and Non-Fallers in Parkinson’s Disease

Araújo

Smaili

Morris

et al. 2023

Sensors

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Although the multifactorial nature of falls in Parkinson’s disease (PD) is well described, optimal assessment for the identification of fallers remains unclear. Thus, we aimed to identify clinical and objective gait measures that best discriminate fallers from non-fallers in PD, with suggestions of optimal cutoff scores. METHODS: Individuals with mild-to-moderate PD were classified as fallers (n = 31) or non-fallers (n = 96) based on the previous 12 months’ falls. Clinical measures (demographic, motor, cognitive and patient-reported outcomes) were assessed with standard scales/tests, and gait parameters were derived from wearable inertial sensors (Mobility Lab v2); participants walked overground, at a self-selected speed, for 2 min under single and dual-task walking conditions (maximum forward digit span). Receiver operating characteristic curve analysis identified measures (separately and in combination) that best discriminate fallers from non-fallers; we calculated the area under the curve (AUC) and identified optimal cutoff scores (i.e., point closest-to-(0,1) corner). RESULTS: Single gait and clinical measures that best classified fallers were foot strike angle (AUC = 0.728; cutoff = 14.07°) and the Falls Efficacy Scale International (FES-I; AUC = 0.716, cutoff = 25.5), respectively. Combinations of clinical + gait measures had higher AUCs than combinations of clinical-only or gait-only measures. The best performing combination included the FES-I score, New Freezing of Gait Questionnaire score, foot strike angle and trunk transverse range of motion (AUC = 0.85). CONCLUSION: Multiple clinical and gait aspects must be considered for the classification of fallers and non-fallers in PD.

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Systematic review for the prevention and management of falls and fear of falling in patients with Parkinson's disease

Cited by 14 publications

References 168 publications

Gait Characteristics Associated with Fear of Falling in Hospitalized People with Parkinson’s Disease

Gait Characteristics Associated with Fear of Falling in Hospitalized People with Parkinson’s Disease

Pesquisas Envolvendo Pacientes Com Doença De Parkinson No Brasil – Uma Revisão Integrativa

Combination of Clinical and Gait Measures to Classify Fallers and Non-Fallers in Parkinson’s Disease

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