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Background: Falls are a debilitating problem for people with Parkinson's disease (PD). Objectives: To compare clinical and functional characteristics of non-fallers, single and recurrent fallers (=2 falls); to determine predictors of time to second fall; and to develop a predictive tool for identifying people with PD at different categories of falls risk. Methods: Participants (n = 229) were assessed by disease-specific, self-report and balance measures and followed up for 12 months. Area under the receiver operating characteristic curves (AUC), Kaplan-Meier curves and log-rank test were performed. Selected predictors with p < 0.10 in univariate analysis were chosen to be entered into the Cox regression model. Results: Eighty-four (37%) participants had=2 falls during the follow-up. Recurrent fallers significantly differed from single fallers. The final Cox model included history of =2 falls in the past year (Hazard Ratio [HR] = 3.94; 95% confidence interval [CI] 2.26-6.86), motor fluctuations (HR = 1.91; 95% CI 1.12-3.26), UPDRS activities of daily living (ADL) (HR = 1.10 per 1 point increase; 95% CI 1.06-1.14) and levodopa equivalent dose (LED) (HR = 1.09 per 100 mg increase; 95% CI 1.02-1.16). A 3-predictor tool included history of =2 falls in the past year, motor fluctuations and UPDRS ADL >12 points (AUC= 0.84; 95% CI 0.78-0.90). By adding LED >700 mg/day and Berg balance scale =49 points, a 5-predictor tool was developed (AUC= 0.86; 95% CI 0.81-0.92). Conclusions: Two predictive tools with moderate-to-high accuracy may identify people with PD at low, medium and high risk of falling recurrently within the next year. However, future studies to address external validation are required. [ABSTRACT FROM AUTHOR]

Background. Balance confidence and fear of falling are factors associated with recurrent falls in people with Parkinson disease (PD). However, the accuracy for predicting falls on the basis of self-report measures has not been widely investigated. Objective. The study objectives were: (1) to compare the accuracy of the Activities- specific Balance Confidence Scale (ABC) and the Falls Efficacy Scale-International (FES-I) with that of the Berg Balance Scale (BBS), Dynamic Gait Index (DGI), Functional Reach Test (FRT), and Timed "Up & Go" Test (TUG) for predicting recurrent falls in people with PD and (2) to explore the ability of combinations of up to 3 tests to predict recurrent falls. Design. This was a prospective cohort study involving 225 people with PD. Methods. Participants were assessed with the ABC, FES-I, BBS, FRT, TUG, and DGI. Participants who reported 2 or more falls in the 12-month follow-up period were classified as recurrent fallers. Areas under the receiver operating characteristic curves were determined, and the Akaike information criterion was used to select the best predictive model. Results. Eighty-four participants (37.3%) were classified as recurrent fallers. Areas under the receiver operating characteristic curves for the ABC, FES-I, TUG, FRT, DGI, and BBS were 0.73, 0.74, 0.72, 0.74, 0.76, and 0.79, respectively. Two-test models provided additional discriminating ability compared with individual measures and had Akaike information criterion values similar to those of 3-test models, particularly the combination of the BBS with the FES-I. Limitations. The lack of an external validation sample was a limitation of this study. Conclusions. The ABC and FES-I demonstrated moderate accuracy in predicting recurrent falls and a predictive ability similar to that of performance-based balance measures, especially the FRT and the TUG. Two-test models showed performance similar to that of 3-test models, suggesting that a combination of 2 measures may improve the ability to predict recurrent falls in people with PD. Specifically, the combination of the BBS with the FES-I may be considered. [ABSTRACT FROM AUTHOR]

Background: Predictors of falls in people with Parkinson's disease (PD) who have not previously fallen are yet to be identified. Objectives: We aimed to identify predictors of all falls and recurrent falls in people with PD who had not fallen in the previous year and to explore the timing of falls in a 12-month follow-up period. Methods: Participants withPD(n = 130) were assessed by disease-specific, self-report and balance measures. Falls were recorded prospectively for 12 months. Univariate and multivariate analyses were performed. Kaplan-Meier survival analysis was used to investigate time to falling. Results: Forty participants (31%) had≥1 fall during follow-up and 21 (16%) had≥2 falls. Disability, reduced balance confidence and greater concern about falling were associated with ≥1 fall in univariate analyses. Additionally, PD duration and severity, freezing of gait and impaired balance were associated with ≥2 falls (p < 0.05). Disability (Schwab and England scale, Odds Ratio [OR] = 0.56 per 10 points increase; 95% confidence interval [CI] 0.39–0.80; p = 0.002) was associated with ≥1 fall in the final multivariate model (area under the receiver operating characteristic curve [AUC] = 0.65; 95% CI 0.55–0.76; p = 0.005). Disability (Unified Parkinson's Disease Rating Scale activities of daily living, OR= 1.20; 95% CI 1.07–1.34; p = 0.001) and levodopa equivalent dose (OR = 1.11 per 100 mg increase; 95% CI 0.95–1.30; p = 0.19) were associated with ≥2 falls in the final multivariate model (AUC= 0.72; 95% CI 0.60–0.84; p = 0.001). Recurrent fallers experienced their first fall earlier than single fallers (p < 0.05). Conclusions: Self-reported disability was the strongest single predictor of all falls and recurrent falls. [ABSTRACT FROM AUTHOR]

Objective: To externally validate the Recurrent Fall Risk Scale (ReFR) in community-dwelling stroke survivors., Methods: Cohort of stroke survivors with independent gait ability recruited from a reference outpatient stroke clinic. Besides sociodemographic and clinical data, the following scales were used: Modified Barthel Index (mBI), ReFR scale and National Institutes of Health Stroke Scale (NIHSS). Participants were followed up for 12 months to record the incidence of falls. Accuracy of the ReFR scale was measured by the area under the ROC curve., Results: One hundred and thirteen individuals were recruited between April 2016 and November 2016: mean age 54 years (± 14), 55% women, median time since the last stroke 24 months (range 12 -48 months), posterior vascular territory affected in 35% of the sample. Median NIHSS was 3 (range 1 to 6), median mBI 49 (range 46-50), median ReFR 3 (range 2 to 5). During the follow-up period, 32 (33%) subjects had at least one fall and 18 (19%) were recurrent fallers (two or more falls). The accuracy of ReFR scale was 0.67 (95% CI = 0.54-0.79), p = 0.026., Conclusion: This study externally validated the ReFR as a tool to predict recurrent falls in individuals after stroke., (Copyright © 2020 Elsevier Inc. All rights reserved.)