Abstract
BackgroundPatients with Parkinson's disease (PD) suffer from a high fall risk. Previous approaches for evaluating fall risk are based on self-report or testing at a given time point and may, therefore, be insufficient to optimally capture fall risk. We tested, for the first time, whether metrics derived from 3 day continuous recordings are associated with fall risk in PD.Methods and Materials107 patients (Hoehn & Yahr Stage: 2.6±0.7) wore a small, body-fixed sensor (3D accelerometer) on lower back for 3 days. Walking quantity (e.g., steps per 3-days) and quality (e.g., frequency-derived measures of gait variability) were determined. Subjects were classified as fallers or non-fallers based on fall history. Subjects were also followed for one year to evaluate predictors of the transition from non-faller to faller.ResultsThe 3 day acceleration derived measures were significantly different in fallers and non-fallers and were significantly correlated with previously validated measures of fall risk. Walking quantity was similar in the two groups. In contrast, the fallers walked with higher step-to-step variability, e.g., anterior-posterior width of the dominant frequency was larger (p = 0.012) in the fallers (0.78±0.17 Hz) compared to the non-fallers (0.71±0.07 Hz). Among subjects who reported no falls in the year prior to testing, sensor-derived measures predicted the time to first fall (p = 0.0034), whereas many traditional measures did not. Cox regression analysis showed that anterior-posterior width was significantly (p = 0.0039) associated with time to fall during the follow-up period, even after adjusting for traditional measures.Conclusions/SignificanceThese findings indicate that a body-fixed sensor worn continuously can evaluate fall risk in PD. This sensor-based approach was able to identify transition from non-faller to faller, whereas many traditional metrics were not successful. This approach may facilitate earlier detection of fall risk and may in the future, help reduce high costs associated with falls.
Highlights
Falls are a debilitating problem among patients with Parkinson’s disease (PD), leading to diminished mobility, poor quality of life, morbidity, and mortality [1,2]
Metrics based on the evaluation of the risk of falls of patients with PD over a relatively extended time period, as subjects carry out their routine activities of daily living in their home and community environment may be one of the keys to improving the reliability and sensitivity of the assessment of fall risk
The present findings confirm that traditional measures of fall risk, i.e., fall history, gait, freezing of gait, and reduced performance on functional-performance tests of mobility, are associated with fall risk in patients with PD [1,4,5,6,7]
Summary
Falls are a debilitating problem among patients with Parkinson’s disease (PD), leading to diminished mobility, poor quality of life, morbidity, and mortality [1,2]. Metrics based on the evaluation of the risk of falls of patients with PD over a relatively extended time period, as subjects carry out their routine activities of daily living in their home and community environment may be one of the keys to improving the reliability and sensitivity of the assessment of fall risk. These metrics could potentially allow for earlier intervention and, lower the high costs that result from falls. For the first time, whether metrics derived from 3 day continuous recordings are associated with fall risk in PD
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