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Arch Phys Med Rehabil. 2016 Mar;97(3):372-379.e1. doi: 10.1016/j.apmr.2015.10.105. Epub 2015 Dec 1.

Two-Year Trajectory of Fall Risk in People With Parkinson Disease: A Latent Class Analysis.

Author information

1
Department of Physical Therapy, University of Utah, Salt Lake City, UT; The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
2
Department of Physical Therapy, University of Utah, Salt Lake City, UT.
3
Program in Physical Therapy, Washington University School of Medicine in St Louis, St Louis, MO; Department of Neurology, Washington University School of Medicine in St Louis, St Louis, MO.
4
Department of Physical Therapy, University of New England, Portland, ME.
5
Department of Physical Therapy and Athletic Training, Boston University, Boston, MA.
6
Program in Physical Therapy, Washington University School of Medicine in St Louis, St Louis, MO; Department of Neurology, Washington University School of Medicine in St Louis, St Louis, MO; Department of Anatomy and Neurobiology, Washington University School of Medicine in St Louis, St Louis, MO.
7
Department of Physical Therapy, University of Alabama at Birmingham School of Health Professions, Birmingham, AL.
8
Department of Physical Therapy, University of Utah, Salt Lake City, UT. Electronic address: lee.dibble@hsc.utah.edu.

Abstract

OBJECTIVE:

To examine fall risk trajectories occurring naturally in a sample of individuals with early to middle stage Parkinson disease (PD).

DESIGN:

Latent class analysis, specifically growth mixture modeling (GMM), of longitudinal fall risk trajectories.

SETTING:

Assessments were conducted at 1 of 4 universities.

PARTICIPANTS:

Community-dwelling participants with PD of a longitudinal cohort study who attended at least 2 of 5 assessments over a 2-year follow-up period (N=230).

INTERVENTIONS:

Not applicable.

MAIN OUTCOME MEASURES:

Fall risk trajectory (low, medium, or high risk) and stability of fall risk trajectory (stable or fluctuating). Fall risk was determined at 6 monthly intervals using a simple clinical tool based on fall history, freezing of gait, and gait speed.

RESULTS:

The GMM optimally grouped participants into 3 fall risk trajectories that closely mirrored baseline fall risk status (P=.001). The high fall risk trajectory was most common (42.6%) and included participants with longer and more severe disease and with higher postural instability and gait disability (PIGD) scores than the low and medium fall risk trajectories (P<.001). Fluctuating fall risk (posterior probability <0.8 of belonging to any trajectory) was found in only 22.6% of the sample, most commonly among individuals who were transitioning to PIGD predominance.

CONCLUSIONS:

Regardless of their baseline characteristics, most participants had clear and stable fall risk trajectories over 2 years. Further investigation is required to determine whether interventions to improve gait and balance may improve fall risk trajectories in people with PD.

KEYWORDS:

Accidental falls; Gait; Longitudinal studies; Parkinson disease; Rehabilitation; Risk

PMID:
26606871
PMCID:
PMC4769916
[Available on 2017-03-01]
DOI:
10.1016/j.apmr.2015.10.105
[Indexed for MEDLINE]
Free PMC Article

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