Clinical Usefulness of Retropulsion Tests in Persons with Mild to Moderate Parkinson's Disease.

Beata Lindholm,Per Odin,Peter Hagell,Erika Franzén,Wojciech Duzynski

doi:10.3390/ijerph182312325

Abstract

People with Parkinson’s disease (PwPD) have an increased risk for falls and near falls. They have particular difficulties with maintaining balance against an external perturbation, and several retropulsion tests exist. The Unified PD Rating Scale item 30 (UPDRS30) is the most common, involving an expected shoulder pull. Others recommend using an unexpected shoulder pull, e.g., the Nutt Retropulsion Test (NRT). We aimed to evaluate the clinical usefulness of these tests for detecting future fallers. By using two different golden standards related to self-reported prospective falls and near falls over 6 months following two different time points with 3.5 years between, we estimated sensitivity/specificity, Youden index, predictive values, and likelihood ratios for each test. The different time points yielded a different prevalence of falls and near falls, as well as different predictive values. When comparing the performance of the NRT and UPDRS30 for detecting future fallers, we found that the NRT consistently performed better than UPDRS30. However, neither test exhibited optimal performance in terms of predictive values and associated likelihood ratios. Our findings speak against using either of these tests as a single assessment for this purpose and support previous recommendations of using a multifactorial approach when targeting balance problems in PwPD.

Highlights

Postural instability, i.e., impaired reactive balance, is one of the four cardinal features of Parkinson’s disease (PD)
The prevalence of falls and near falls varies between 31–90% [1,2,3] and 26–75% [4,5,6,7], respectively
At T1, the sample consisted of 146 people with PD (PwPD) (46% women) with a mean age of 68 (SD, 9.6)

Summary

Introduction

I.e., impaired reactive balance, is one of the four cardinal features of Parkinson’s disease (PD). Falls and postural instability are common already in the early stages of PD [1,2] and increase with disease progression [3]. Transfers and activities in everyday life, such as transferring to/from sitting, walking, and turning, induce self-generated perturbations that challenge reactive balance responses [8] and predispose people with PD (PwPD) to falls [9,10,11]. Walking is challenging since the body is in a state of imbalance, and the only way to prevent falling is to take the step [12]. Passing over a carpet or transitioning between tiled and wooden surfaces have been identified as the most common environmental factors for falls indoors among

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Conclusion