Abstract
ObjectiveTo evaluate the predictive validity of multimodal clinical assessment outcomes and quantitative measures of in- and off-laboratory mobility for fall-risk estimation in patients with different forms of neurological gait disorders.MethodsThe occurrence, severity, and consequences of falls were prospectively assessed for 6 months in 333 patients with early stage gait disorders due to vestibular, cerebellar, hypokinetic, vascular, functional, or other neurological diseases and 63 healthy controls. At inclusion, participants completed a comprehensive multimodal clinical and functional fall-risk assessment, an in-laboratory gait examination, and an inertial-sensor-based daily mobility monitoring for 14 days. Multivariate logistic regression analyses were performed to identify explanatory characteristics for predicting the (1) the fall status (non-faller vs. faller), (2) the fall frequency (occasional vs. frequent falls), and (3) the fall severity (benign vs. injurious fall) of patients.Results40% of patients experienced one or frequent falls and 21% severe fall-related injuries during prospective fall assessment. Fall status and frequency could be reliably predicted (accuracy of 78 and 91%, respectively) primarily based on patients' retrospective fall status. Instrumented-based gait and mobility measures further improved prediction and provided independent, unique information for predicting the severity of fall-related consequences.InterpretationFalls- and fall-related injuries are a relevant health problem already in early stage neurological gait disorders. Multivariate regression analysis encourages a stepwise approach for fall assessment in these patients: fall history taking readily informs the clinician about patients' general fall risk. In patients at risk of falling, instrument-based measures of gait and mobility provide critical information on the likelihood of severe fall-related injuries.
Highlights
Gait disturbances and associated falls are common complications in neurological diseases, and compromise patients’ mobility, functional independence, and quality of life [1].The prevalence for gait impairments and injurious falls is considerably higher in central compared to peripheral neurological disorders [2]
Inclusion criteria were the presence of a chronic gait disorder due to (1) a peripheral vestibular disorder, (2) a cerebellar disorder, (3) a functional disorder, (4) a hypokinetic disorder, (5) a vascular disorder, and (6) patients with other neurological disorders that were referred to the center due to gait instability and/or falls
healthy controls (HC) and patients did not differ in age, except patients with hypokinetic disorders that were in average older (F6,365 = 2.1, p = 0.043)
Summary
Gait disturbances and associated falls are common complications in neurological diseases, and compromise patients’ mobility, functional independence, and quality of life [1]. The prevalence for gait impairments and injurious falls is considerably higher in central compared to peripheral neurological disorders [2]. Fall-related injuries entail substantial medical costs and determine patients’ mortality risk [3]. Different algorithms for the assessment of fall risk in neurological gait disorders have been evaluated. Diseasespecific clinical scales frequently fail to reliably predict falls in respective clinical cohorts [4, 5]. More general and comprehensive algorithms that include questionnairebased surveys of sociodemographic and disease-related risk factors and clinical ratings of functional mobility (e.g., Timed-up-and-go Test) only yield moderate validity in fall prediction [6]
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