Multiple Fallers Research Articles

Falls and Physical Activity in Persons With Mild to Moderate Dementia Participating in an Intensive Motor Training: Randomized Controlled Trial.

Physical activity is beneficial in people with dementia. As physical activity increases risk exposure for falls, safety concerns arise. Prior exercise trials in people with dementia have not measured physical activity. Falls in relation to exposure time rather than person-years as outcome measure has been promoted but not investigated in people with dementia. Patients with mild to moderate dementia (n=110) were randomized to an intensive, progressive strength and functional training intervention or to a low-intensity group training for 12 weeks each. Physical activity was measured with a standardized questionnaire. Falls were documented prospectively by calendars for 12 months. During the intervention, physical activity was significantly higher in the intervention group (P<0.001) without an increased fall rate (intervention group vs. 2.89 vs. 1.94; incidence rate ratio, 1.49; 95% confidence interval, 0.66-3.36; P=0.333). In the subgroup of multiple fallers, the number of falls per 1000 hours of activity was significantly lower in the intervention group (8.85 vs. 18.67; P=0.017). Increased physical activity during exercise intervention was safe in people with mild to moderate dementia. Fall rate adjusted for physical activity is a useful and sensitive outcome measure in addition to fall rate per person-years.

Clinical effectiveness and cost-effectiveness of a multifaceted podiatry intervention for falls prevention in older people: a multicentre cohort randomised controlled trial (the REducing Falls with ORthoses and a Multifaceted podiatry intervention trial).

Falls are a serious cause of morbidity and cost to individuals and society. Evidence suggests that foot problems and inappropriate footwear may increase the risk of falling. Podiatric interventions could help reduce falls; however, there is limited evidence regarding their clinical effectiveness and cost-effectiveness. To determine the clinical effectiveness and cost-effectiveness of a multifaceted podiatry intervention for preventing falls in community-dwelling older people at risk of falling, relative to usual care. A pragmatic, multicentred, cohort randomised controlled trial with an economic evaluation and qualitative study. Nine NHS trusts in the UK and one site in Ireland. In total, 1010 participants aged ≥ 65 years were randomised (intervention, n = 493; usual care, n = 517) via a secure, remote service. Blinding was not possible. All participants received a falls prevention leaflet and routine care from their podiatrist and general practitioner. The intervention also consisted of footwear advice, footwear provision if required, foot orthoses and foot- and ankle-strengthening exercises. The primary outcome was the incidence rate of falls per participant in the 12 months following randomisation. The secondary outcomes included the proportion of fallers and multiple fallers, time to first fall, fear of falling, fracture rate, health-related quality of life (HRQoL) and cost-effectiveness. The primary analysis consisted of 484 (98.2%) intervention and 507 (98.1%) usual-care participants. There was a non-statistically significant reduction in the incidence rate of falls in the intervention group [adjusted incidence rate ratio 0.88, 95% confidence interval (CI) 0.73 to 1.05; p = 0.16]. The proportion of participants experiencing a fall was lower (50% vs. 55%, adjusted odds ratio 0.78, 95% CI 0.60 to 1.00; p = 0.05). No differences were observed in key secondary outcomes. No serious, unexpected and related adverse events were reported. The intervention costs £252.17 more per participant (95% CI -£69.48 to £589.38) than usual care, was marginally more beneficial in terms of HRQoL measured via the EuroQoL-5 Dimensions [mean quality-adjusted life-year (QALY) difference 0.0129, 95% CI -0.0050 to 0.0314 QALYs] and had a 65% probability of being cost-effective at the National Institute for Health and Care Excellence threshold of £30,000 per QALY gained. The intervention was generally acceptable to podiatrists and trial participants. Owing to the difficulty in calculating a sample size for a count outcome, the sample size was based on detecting a difference in the proportion of participants experiencing at least one fall, and not the primary outcome. We are therefore unable to confirm if the trial was sufficiently powered for the primary outcome. The findings are not generalisable to patients who are not receiving podiatry care. The intervention was safe and potentially effective. Although the primary outcome measure did not reach significance, a lower fall rate was observed in the intervention group. The reduction in the proportion of older adults who experienced a fall was of borderline statistical significance. The economic evaluation suggests that the intervention could be cost-effective. Further research could examine whether or not the intervention could be delivered in group sessions, by physiotherapists, or in high-risk patients. Current Controlled Trials ISRCTN68240461. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 24. See the NIHR Journals Library website for further project information.

Spinal sagittal balance status affects postoperative actual falls and quality of life after decompression and fusion in-situ surgery in patients with lumbar spinal stenosis

ObjectivesIt has been reported that good spinal sagittal alignment reduces the risk of fall and positive sagittal balance is the radiographic parameter that is most highly correlated with adverse health outcomes. However, no reports have demonstrated a change in risk of falling in patients with lumbar spinal stenosis (LSS) according to sagittal balance status. Patients and methodsFrom September 2013 to October 2014, 141 patients who underwent lumbar spine surgery, including decompression and fusion in-situ for LSS, were enrolled in this study. Based on sagittal balance status, patients were divided into sagittal balance (SB) and sagittal imbalance (SI) groups. Four functional mobility tests were used to evaluate the risk of falling, and a fall diary, Oswestry disability index (ODI), and the Euro-QoL 5D(EQ-5D) visual analogue scale (VAS) were utilized to assess clinical improvement. ResultsThe mean patient age was 70.1 years in the SB group (N=46) and 70.9 years in the SI group (N=95) (not significant). The mean C7PL was 7.9mm in the SB group and 66.1mm in the SI group preoperatively (p<0.05). Among the four functional tests, only postoperative SMT and STS improved significantly in the SB group (p<0.05). Patients in the SI group showed significantly improved scores for all four functional tests during postoperative follow-up (p<0.05), but their performance was still worse than patients in the SB group. Average number of falls per individual during the follow-up period was 1.1±2.5 in the SB group and 1.9±3.2 in the SI group (p<0.05). There was a significant difference in the distribution of non-fallers and fallers (single and multiple fallers) between the two groups postoperatively(p<0.05). ODI and the EQ-5D VAS showed greater improvement in the SB group than the SI group. Multiple regression analysis revealed that sagittal balance during follow-up significantly affected ODI, EQ-VAS, functional mobility tests. (p<0.05). ConclusionTherefore, when fusion surgery is planned in patients with LSS, careful consideration of sagittal balance status might be important to attain better surgical and functional outcomes and decrease the incidence of actual falls after surgical treatment.

Falls in people prior to undergoing total hip or total knee replacement surgery: Frequency and associated factors

BackgroundTotal hip/total knee replacement (THR/TKR) surgery is becoming an increasingly common approach for the management of primarily lower limb osteoarthritis. A number of factors such as reducing mobility, structural joint changes, and pain may predispose those awaiting hip and knee surgery to falls, which may impact on pre- and postsurgery functions. The aim of this study was to identify the prevalence of falls in the year preceding THR/TKR surgery, and factors associated with falls. MethodsCross-sectional survey of patients scheduled for THR/TKR, including measures of joint disease severity, falls, falls efficacy, quality of life, pain, and depression. Comparisons across falls status (nonfaller, single faller, or multiple faller) and high/low disease severity for both THR and TKR groups were undertaken. ResultsA total of 282 people (mean age 67.3 years) completed surveys before the surgery (197 TKR). As much as 41% reported one or more falls in the preceding year, and participants reported that the affected joint contributed to the fall in 35% of the cases. TKR multiple fallers (≥ 2 falls) had significantly lower falls efficacy, worse function, greater pain catastrophizing and depression, and poorer 36-Item Short Form Survey Mental Component Scores than nonmultiple fallers. For both THR and TKR groups, several measures were significantly worse for those with greater disease severity, including falls efficacy, depression, pain catastrophizing, self-rated health, and physical activity. ConclusionFalls are common in the 12 months preceding total hip or knee surgery. A number of factors are associated with risk of multiple falls and with joint disease severity. Strategies to reduce falls risk should be a priority in the year preceding lower limb joint surgery to optimize presurgery and postsurgery outcomes.

Predicting Falls in Older Adults

Accelerometers have been evaluated extensively regarding their ability to assess postural sway. Horizontal center of mass (COM) accelerations have been reported to be positively associated fall risk in older adult populations. In fact, we previously reported that an accelerometer-based balance assessment (ABA) was superior to select clinical measures at retrospectively discriminating fallers from non-fallers. PURPOSE: Understanding that a retrospective analysis of fall risk is inherently flawed, we aimed to prospectively evaluate the ABA. METHODS: Ninety-three independent community-living otherwise healthy older adults (age 86±6 years) were recruited from multiple facilities. For the baseline assessment, participants completed the ABA (8 static balance tasks), Timed Up-and-Go (TUG), Berg Balance Scale (BBS), and the Activities-Specific Balance Confidence (ABC) Scale. Participants were then called weekly for 12 months to evaluate falls after the baseline assessment. We then compared outcomes from the ABA and clinical assessments between participants who never fell, participants who fell once, and participants who fell two or more times during the follow-up period. RESULTS: During the 12-month follow-up, 22/93 (24%) of the participants fell once and 32/93 (34%) fell at least twice. The average root mean square of the horizontal COM accelerations across the 8 ABA static balance conditions for non-fallers, one time fallers, and multiple fallers (0.0126 ± 0.0049 g, 0.0122 ± 0.0030 g, and 0.0129 ± 0.0042 g, respectively) were statistically similar. Likewise, there were no significant differences between non-fallers, one time fallers, and multiple fallers with respect to the TUG (15.7 ± 12.0 s, 17.1 ± 10.2 s, and 12.8 ± 4.7 s, respectively), BBS (46.7 ± 7.4, 45.1 ± 10.1, and 47.3 ± 5.1, respectively), or the ABC Scale (69.6 ± 19.1, 68.0 ± 16.2, and 65.8 ± 18.1, respectively). CONCLUSIONS: In this 12-month prospective study, 58% of our study population fell at least once, but baseline performance on the ABA, TUG, BBS, and ABC Scale was not significantly associated with future single or multiple falls.

The ability of functional mobility tests to identify elderly with recurrent falls

Introduction: Falls are common and often a devastating problem among elderly people causing a tremendous amount of morbidity, mortality and use of health care facilities. Prognostic tools are needed to identify elders with an increased risk of falling in order to take preventive actions. Frequently used tools include Timed Up and Go test (TUG), Five times Sit To Stand (5-STS) and Six Meter Walk Test (SMWT). The present study was performed to assess whether the TUG, 5-STS and SMWT were different between elderly fallers and non fallers, and to test their ability to discriminate them. Methods: Study was carried out on hospital patients in a tertiary care hospital in the Southern province. Elderly patients attending medical clinics in this hospital were considered for the selection of study sample. Patients who self reported multiple falls within the previous 12 months were recruited as cases and age and sex matched patients without falls during last 12 months were recruited as controls. Results: There is no significant difference between the mean durations of SMWT and 5-STS among fallers and non-fallers. However, mean duration for the test TUG was significantly higher among fallers compared to nonfallers. According to the ROC analysis, best TUG cut- off point to identify the fallers was 11.8 seconds which was associated with sensitivity of 80% and specificity of 60%. Conclusion: Of the mobility tests examined, TUG provided the best discrimination between multiple fallers and non-fallers. Thus it can be used to identify the patients who are at risk of falls. DOI: http://dx.doi.org/10.4038/gmj.v19i2.7906 Galle Medical Journal 2014 19(2): 1-5

Muscle Strength of Lower Extremities Related to Incident Falls in Community- Dwelling Older Adults

Aim: In order to propose rehabilitation strategies for the reduction of falls risk, thereby preventing falls in older adults, the present study aimed to examine the associations between muscle strength of lower extremities and actual incidence of falls during the 24 weeks follow-up period. Methods: Ninety-nine patients who were attending geriatric outpatient clinic participated and were subjected for analysis. All participants were assessed their physical performances using Motor Fitness Scale and Timed Up and Go test. Muscle strengths of lower extremities were also measured. Incident falls of the participants during the 24 weeks follow-up period were recorded. Results: A binary logistic stepwise regression analysis incorporating all the possible variables into the model revealed that sex (being female) was predictive of frequent falls. Based on the results, the subgroup analysis focusing only on female participants (9 multiple fallers and 49 non-multiple fallers) was carried out using the same definition used in the initial analysis. The results indicated that no lower muscle strengths explained the number of falls in non-multiple fallers, whereas in multiple fallers, plantar flexor muscle strength significantly predicted incident falls during the observation period. Conclusion: Our findings suggested that a standard assessment of muscle strength is a useful component in the risk assessment of falls in a sample of community-dwelling older patients. In particular ankle plantar flexor muscle strength was confirmed to be a predictor of falls in older female patients, therefore might be crucial in considering effective rehabilitation program to prevent falls.

The REFORM study protocol: a cohort randomised controlled trial of a multifaceted podiatry intervention for the prevention of falls in older people

IntroductionFalls and fall-related injuries are a serious cause of morbidity and cost to society. Foot problems and inappropriate footwear may increase the risk of falls; therefore podiatric interventions may play...

Validation of an accelerometer-based fall prediction model.

Falls are a common and serious problem faced by older populations. There is a growing interest in estimating the risk of falling for older people using body-worn sensors and simple movement tasks, allowing appropriate fall prevention programs to be administered in a timely manner to the high risk population. This study investigated the capability and validity of using a waist-mounted triaxial accelerometer (TA) and a directed routine (DR) that includes three movement tasks to discriminate between fallers and non-fallers and between multiple fallers and non-multiple fallers. Data were collected from 98 subjects who were stratified into two separate groups, one for model training and the other for model validation. Logistic regression models were constructed using the TA features from the entire DR and from each single DR task, and were validated using unseen data. The best models were obtained using features from the alternate step test to classify between fallers and non-fallers with κ = 0.34-0.41, sensitivity = 68%-71% and specificity = 63%-73%. However, the overall validation performances were poor. The study emphasizes the importance of independent validation in fall prediction studies.

Identifying Fallers and Nonfallers With the Maximal Base of Support Width (BSW): A One-year Prospective Study

The purpose of this prospective cohort study was to determine whether the maximal width of the base of support (BSW) measure is able to predict the risk of multiple falls in community-dwelling women. Thirty-eight community-dwelling women (mean age of 72 ± 8 years old) participated. Falls were prospectively recorded during the following year. Overall, 29 falls were recorded; six (16%) women were multiple fallers and 32 (84%) were nonfallers. There was a significant difference in the BSW between the fallers and nonfallers (F[1, 37] = 5.134 [p = .030]). A logistic regression analysis indicated a significant contribution of the BSW test to the model (odds ratio = 0.637; 95% CI [0.407, 0.993]; p = .046 per 1 cm).The cut-off score was determined to be 27.8 cm (67% sensitivity and 84% specificity). These results indicate that women with a smaller BSW at baseline had a significantly higher risk of sustaining a fall.

Fallers in Postacute Rehabilitation Have Worse Functional Recovery and Increased Health Services Use

To determine characteristics associated with single and multiple fallers during postacute rehabilitation and to investigate the relationship among falls, rehabilitation outcomes, and health services use. Retrospective cohort study. Geriatric postacute rehabilitation hospital. Patients (n= 4026) consecutively admitted over a 5-year period (2003-2007). All falls during hospitalization were prospectively recorded. Collected patients' characteristics included health, functional, cognitive, and affective status data. Length of stay and discharge destination were retrieved from the administrative database. During rehabilitation stay, 11.4% (458/4026) of patients fell once and an additional 6.3% (253/4026) fell several times. Compared with nonfallers, fallers were older and more frequently men. They were globally frailer, with lower Barthel score and more comorbidities, cognitive impairment, and depressive symptoms. In multivariate analyses, compared with 1-time fallers, multiple fallers were more likely to have lower Barthel score (adjOR: 2.45, 95% CI: 1.48-4.07; P= .001), cognitive impairment (adjOR: 1.43, 95% CI: 1.04-1.96; P= .026), and to have been admitted from a medicine ward (adjOR: 1.55, 95% CI: 1.03-2.32; P= .035). Odds of poor functional recovery and institutionalization at discharge, as well as length of stay, increased incrementally from nonfallers to 1-time and to multiple fallers. In these patients admitted to postacute rehabilitation, the proportion of fallers and multiple fallers was high. Multiple fallers were particularly at risk of poor functional recovery and increased health services use. Specific fall prevention programs targeting high-risk patients with cognitive impairment and low functional status should be developed in further studies.

Gait Analysis With Cognitive-Motor Dual Tasks to Distinguish Fallers From Nonfallers Among Rehabilitating Stroke Patients

ObjectivesTo evaluate fall risk in stroke patients based on single- and dual-task gait analyses, and to investigate the difference between 2 cognitive tasks in the dual-task paradigm. DesignProspective cohort study. SettingRehabilitation hospitals. ParticipantsSubacute stroke patients (N=32), able to walk without physical/manual help with or without walking aids, while performing a verbal task. InterventionsNot applicable. Main Outcome MeasuresFunctional gait measures were Functional Ambulation Categories (FAC) and use of a walking aid. Gait measures were evaluated by an electronic walkway system under single- and dual-task (DT) conditions. For the single-task, subjects were instructed to walk at their usual speed. One of the DTs was a verbal fluency dual task, whereby subjects had to walk while simultaneously enumerating as many different animals as possible. For the other DT (counting dual task), participants had to walk while performing serial subtractions. After inclusion, participants kept a 6-month falls diary. ResultsEighteen (56.3%) of the 32 included patients fell. Ten (31.3%) were single fallers (SFs), and 8 (25%) were multiple fallers (MFs). Fallers (Fs) more frequently used a walking aid and more frequently needed an observatory person for walking safely (FAC score of 3) than nonfallers (NFs). Two gait decrement parameters in counting dual task could distinguish potential Fs from NFs: decrement in stride length percentage (P=.043) and nonparetic step length percentage (P=.047). Regarding the division in 3 groups (NFs, SFs, and MFs), only MFs had a significantly higher percentage of decrement for paretic step length (P=.023) than SFs. ConclusionsExamining the decrement of spatial gait characteristics (stride length and paretic and nonparetic step length) during a DT addressing working memory can identify fall-prone subacute stroke patients.

Falls in People With Multiple Sclerosis Who Use a Walking Aid: Prevalence, Factors, and Effect of Strength and Balance Interventions

ObjectivesTo investigate falls prevalence, factors associated with falling, and the effects of balance and strengthening interventions on falls in persons with multiple sclerosis (MS). DesignBaseline and posttreatment data from a randomized controlled trial. SettingCommunity. ParticipantsPeople with MS (N=111) who use bilateral support for gait. InterventionsGroup and one-on-one physiotherapy. Main Outcome MeasuresFalls prevalence was assessed using retrospective recall. Demographic information was collected, impairments of body function were assessed, and results from the Berg Balance Scale, 6-minute walk test (6MWT), Multiple Sclerosis Impact Scale-29 version 2 physical and psychological scores, and the Modified Fatigue Impact Scale (MFIS) were obtained. ResultsThe prevalence of falls in a 3-month period was 50.5% among participants with MS, of whom 28% had more than 1 fall. Fallers had a greater physical (mean difference, −3.9; P=.048) and psychological (median difference, −4.5; P=.001) impact of MS and a greater impact of fatigue (mean difference, −9.4; P=.002). A logistic regression analysis found that the MFIS score made a unique, significant contribution to the model (odds ratio=1.04; 95% confidence interval, 1.018–1.079), correctly identifying 68% of fallers. A 10-week group physiotherapy intervention significantly reduced both the number of fallers (58.3% before to 22.9% after intervention, P=.005) and the number of falls (63 before to 25 after intervention, P=.001). ConclusionsThe prevalence of falls is high in this population of persons with MS, and the impact of MS and of fatigue is greater in fallers. Development and evaluation of interventions to reduce falls risk and the transition to faller or multiple faller status are required.

THE QUICKSCREEN TOOL—A VALIDATED FALLS RISK ASSESSMENT, DEVELOPED AND IMPLEMENTED IN AUSTRALIA FOR USE IN PRIMARY CARE

BackgroundFalling in older age presents a major challenge to health systems and older people. This abstract forms part of the symposium: ‘Integrating Older Adult Falls Prevention into Clinical Practice—Experiences from...

Gait parameter risk factors for falls under simple and dual task conditions in cognitively impaired older people

Impaired gait may contribute to the increased rate of falls in cognitively impaired older people. We investigated whether gait under simple and dual task conditions could predict falls in this group. The study sample consisted of 64 community dwelling older people with mild to moderate cognitive impairment. Participants walked at their preferred speed under three conditions: (a) simple walking, (b) walking while carrying a glass of water and (c) walking while counting backwards from 30. Spatiotemporal gait parameters were measured using the GAITRite® mat. Falls were recorded prospectively for 12months with the assistance of carers. Twenty-two (35%) people fell two or more times in the 12month follow-up period. There was a significant main effect of gait condition and a significant main effect of faller status for mean value measures (velocity, stride length, double support time and stride width) and for variability measures (swing time variability and stride length variability). Examination of individual gait parameters indicated that the multiple fallers walked more slowly, had shorter stride length, spent longer time in double support, had a wider support width and showed more variability in stride length and swing time (p<0.05). There was no significant interaction between gait condition and faller status for any of the gait variables. In conclusion, dual task activities adversely affect gait in cognitively impaired older people. Multiple fallers performed worse in each gait condition but the addition of a functional or cognitive secondary task provided no added benefit in discriminating fallers from non-fallers with cognitive impairment.

Differences in axial segment reorientation during standing turns predict multiple falls in older adults

BackgroundThe assessment of standing turning performance is proposed to predict fall risk in older adults. This study investigated differences in segmental coordination during a 360° standing turn task between older community-dwelling fallers and non-fallers. MethodsThirty-five older adults age mean (SD) of 71 (5.4) years performed 360° standing turns. Head, trunk and pelvis position relative to the laboratory and each other were recorded using a Vicon motion analysis system. Fall incidence was monitored by monthly questionnaire over the following 12 months and used to identify non-faller, single faller and multiple faller groups. ResultsMultiple fallers were found to have significantly different values, when compared to non-fallers, for pelvis onset (p=0.002); mean angular separation in the transverse plane between the head and trunk (p=0.018); peak angular separation in the transverse plane between the trunk and pelvis (p=0.013); and mean angular separation between the trunk and pelvis (p<0.001). ConclusionsOlder adults who subsequently experience multiple falls show a simplified turning pattern to assist in balance control. This may be a predictor for those at increased risk of falling.

Good memory as a predictor of falls: fact or artefact

accurate classification of older people into fallers and non-fallers is crucial for falls research, but largely dependent on the accuracy of fall reporting by the participants. to investigate the influence of memory in relation to fall reporting. five hundred community-dwelling adults aged 70-90 years. memory and executive functioning were assessed using the Rey Auditory Verbal Learning and Trail Making test, respectively. Fall risk was estimated using the physiological profile assessment (PPA). Falls were recorded prospectively for 12 months using monthly falls diaries and follow-up phone calls as required. Spearman correlations showed that falls were significantly correlated to worse executive functioning, worse PPA scores and better memory. People with better memory had an increased risk of being classified as single fallers and multiple fallers, but not when reported injuries were included as part of the definition. good memory appears to influence the recording of falls in community-dwelling older people and likely reflects a reporting bias. In research studies, there may be value in using a combination of injurious falls and multiple falls when classifying people into faller and non-faller groups.

Development of a Clinical Multiple-Lunge Test to Predict Falls in Older Adults

Wagenaar R, Keogh JW, Taylor D. Development of a clinical Multiple-Lunge Test to predict falls in older adults. ObjectiveTo develop a new Multiple-Lunge Test to distinguish between fallers and nonfallers in community-dwelling older adults. DesignA cross-sectional design was used to establish the sensitivity and specificity of the test to predict faller status based on retrospective self-reported fall history. SettingLocal retirement villages. ParticipantsCommunity-dwelling older adults (N=130; mean age ± SD, 77±7y) with (n=40) and without (n=90) a history of falls. InterventionsThe Multiple-Lunge Test required individuals to lunge forward to a step length determined as 60% of their leg length, and return to start, for 5 consecutive repetitions. Interday and intraday test-retest reliability of the Multiple-Lunge Test was established across 2 testing occasions. Main Outcome MeasuresNumber of steps performed correctly, total time to complete 5 steps. ResultsThe Multiple-Lunge Test was found to be reliable across trials (Intraday: intraclass correlation coefficient [ICC]=.79–.81 for steps, ICC=.86–.88 for time; Interday: ICC=.77 for steps; ICC=.84 for time). Sensitivity and specificity values were calculated as 73% and 63%, respectively, for predicting multiple fallers using the measure of all 5 steps done correctly. ConclusionsThe test is easily administered and because of its challenging nature, it may be well suited to detect subtle differences in abilities of higher functioning, community-dwelling older adults. A practitioner can be confident in 7 of 10 cases that an older adult who cannot complete all 5 steps of the Multiple-Lunge Test is at high risk of falls. The results suggest that there is potential for the Multiple-Lunge Test to be used in clinical practice; however, additional research on how to further increase its validity appears warranted.

Activities-Specific Balance Confidence in People with Multiple Sclerosis

Objective. To evaluate the validity of the Activities-specific Balance Confidence scale (ABC) in people with multiple sclerosis (PwMS). Design. A multicentre, cross-sectional study. Setting. Six rural and urban Swedish sites, including specialized units at hospitals and primary care centers. Participants. A sample of 84 PwMS with subjective gait and balance impairment but still able to walk 100 m (comparable with EDSS 1–6). Outcome Measures. Timed Up and Go, Timed Up and Gocog, 25-foot Timed Walk Test, Four Square Step Test, Dynamic Gait Index, Chair Stand Test, 12-item MS Walking Scale, self-reported falls, and use of assistive walking device were used for validation. Results. The concurrent convergent validity was moderate to good (0.50 to −0.75) with the highest correlation found for the 12-item MS Walking Scale. The ABC discriminated between multiple fallers and nonfallers but not between men and women. Ecological validity is suggested since ABC discriminated between users of assistive walking device and nonusers. The internal consistency was high at α = 0.95, and interitem correlations were between 0.30 and 0.83. Conclusion. This study supports the validity of the ABC for persons with mild-to-moderate MS. The participants lacked balance confidence in many everyday activities, likely restricting their participation in society.

Falls and mobility in Parkinson's disease: protocol for a randomised controlled clinical trial

BackgroundAlthough physical therapy and falls prevention education are argued to reduce falls and disability in people with idiopathic Parkinson's disease, this has not yet been confirmed with a large scale randomised controlled clinical trial. The study will investigate the effects on falls, mobility and quality of life of (i) movement strategy training combined with falls prevention education, (ii) progressive resistance strength training combined with falls prevention education, (iii) a generic life-skills social program (control group).Methods/DesignPeople with idiopathic Parkinson's disease who live at home will be recruited and randomly allocated to one of three groups. Each person shall receive therapy in an out-patient setting in groups of 3-4. Each group shall be scheduled to meet once per week for 2 hours for 8 consecutive weeks. All participants will also have a structured 2 hour home practice program for each week during the 8 week intervention phase. Assessments will occur before therapy, after the 8 week therapy program, and at 3 and 12 months after the intervention. A falls calendar will be kept by each participant for 12 months after outpatient therapy.Consistent with the recommendations of the Prevention of Falls Network Europe group, three falls variables will be used as the primary outcome measures: the number of fallers, the number of multiple fallers and the falls rate. In addition to quantifying falls, we shall measure mobility, activity limitations and quality of life as secondary outcomes.DiscussionThis study has the potential to determine whether outpatient movement strategy training combined with falls prevention education or progressive resistance strength training combined with falls prevention education are effective for reducing falls and improving mobility and life quality in people with Parkinson's disease who live at home.Trial registrationAustralia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12606000344594