Serene S Paul1, Anne Thackeray2, Ryan P Duncan3, James T Cavanaugh4, Theresa D Ellis5, Gammon M Earhart6, Matthew P Ford7, K Bo Foreman2, Leland E Dibble8. 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.
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.
Authors: Ryan P Duncan; James T Cavanaugh; Gammon M Earhart; Terry D Ellis; Matthew P Ford; K Bo Foreman; Abigail L Leddy; Serene S Paul; Colleen G Canning; Anne Thackeray; Leland E Dibble Journal: Parkinsonism Relat Disord Date: 2015-05-16 Impact factor: 4.891
Authors: Glenn T Stebbins; Christopher G Goetz; David J Burn; Joseph Jankovic; Tien K Khoo; Barbara C Tilley Journal: Mov Disord Date: 2013-02-13 Impact factor: 10.338
Authors: Ruth M Pickering; Yvette A M Grimbergen; Una Rigney; Ann Ashburn; Gordon Mazibrada; Brian Wood; Peggy Gray; Graham Kerr; Bastiaan R Bloem Journal: Mov Disord Date: 2007-10-15 Impact factor: 10.338
Authors: Mariese A Hely; Wayne G J Reid; Michael A Adena; Glenda M Halliday; John G L Morris Journal: Mov Disord Date: 2008-04-30 Impact factor: 10.338
Authors: Laura Brennan; Kathryn M Devlin; Sharon X Xie; Dawn Mechanic-Hamilton; Baochan Tran; Howard H Hurtig; Alice Chen-Plotkin; Lama M Chahine; James F Morley; John E Duda; David R Roalf; Nabila Dahodwala; Jacqueline Rick; John Q Trojanowski; Paul J Moberg; Daniel Weintraub Journal: J Parkinsons Dis Date: 2017 Impact factor: 5.568