Prevention of falls in Parkinson's disease: a review of fall risk factors and the role of physical interventions.

Falls in people with Parkinson's disease (PD) are frequent and recurrent events with devastating and widespread consequences. Despite this, understanding of the predictive and explanatory value of fall risk factors, as well as the development and testing of interventions aimed at reducing falls, are in their infancy. This review focuses on fall prediction and risk factors that are potentially remediable with physical interventions. We show that falls can be predicted with high accuracy using a simple three-step clinical tool. Evidence from recently published randomized controlled trials supports the implementation of balance-challenging exercises in reducing falls. Larger scale trials utilizing technologically advanced monitoring methods will further elucidate those interventions most likely to be cost effective according to individual risk factor profiles.

[1]  W. Koller Tradozone in essential tremor. Probe of serotoninergic mechanisms. , 1989, Clinical neuropharmacology.

[2]  W. Koller,et al.  Falls and Parkinson's disease. , 1989, Clinical neuropharmacology.

[3]  Gordon H. Guyatt,et al.  Clinical Epidemiology: How to Do Clinical Practice Research , 1991 .

[4]  N. Birbaumer,et al.  Behavioral Treatment of Parkinson's Disease Leads to Improvement of Motor Skills and to Tremor Reduction , 1996 .

[5]  P. Gray,et al.  Fall Risk Factors in Parkinson's Disease , 2000, The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses.

[6]  C. Maher,et al.  A systematic review of workplace interventions to prevent low back pain. , 2000, The Australian journal of physiotherapy.

[7]  R C Wagenaar,et al.  The effects of physical therapy in Parkinson's disease: a research synthesis. , 2001, Archives of physical medicine and rehabilitation.

[8]  R M Pickering,et al.  A community-dwelling sample of people with Parkinson's disease: characteristics of fallers and non-fallers. , 2001, Age and ageing.

[9]  Ann Ashburn,et al.  Predicting Fallers in a Community-Based Sample of People with Parkinson’s Disease , 2001, Gerontology.

[10]  A. Zwinderman,et al.  Prospective assessment of falls in Parkinson's disease , 2001, Journal of Neurology.

[11]  C Stallibrass,et al.  Randomized controlled trial of the Alexander Technique for idiopathic Parkinson's disease , 2002, Clinical rehabilitation.

[12]  R. Walker,et al.  Incidence and prediction of falls in Parkinson's disease: a prospective multidisciplinary study , 2002, Journal of neurology, neurosurgery, and psychiatry.

[13]  Jeffrey M. Hausdorff,et al.  Gait dynamics in Parkinson's disease: relationship to Parkinsonian features, falls and response to levodopa , 2003, Journal of the Neurological Sciences.

[14]  R. Mayeux,et al.  The impact of comorbid disease and injuries on resource use and expenditures in parkinsonism , 2003, Neurology.

[15]  J. Allum,et al.  The impact of comorbid disease and injuries on resource use and expenditures in parkinsonism , 2003, Neurology.

[16]  J. Frank,et al.  Fear of falling and postural control in Parkinson's disease , 2003, Movement disorders : official journal of the Movement Disorder Society.

[17]  M. Dewey,et al.  Education for people with progressive neurological conditions can have negative effects: Evidence from a randomized controlled trial , 2004, Clinical rehabilitation.

[18]  Jeffrey M. Hausdorff,et al.  Falls in outpatients with Parkinson's disease: frequency, impact and identifying factors. , 2005, Journal of neurology.

[19]  Cordelia Erickson-Davis,et al.  Falls and injuries resulting from falls among patients with Parkinson's disease and other parkinsonian syndromes , 2005, Movement disorders : official journal of the Movement Disorder Society.

[20]  C. Becker,et al.  Development of a Common Outcome Data Set for Fall Injury Prevention Trials: The Prevention of Falls Network Europe Consensus , 2005, Journal of the American Geriatrics Society.

[21]  P. Moberg,et al.  Falling risk factors in Parkinson's disease. , 2005, NeuroRehabilitation.

[22]  A. Krygowska-Wajs,et al.  Falls in Parkinson's disease. Causes and impact on patients' quality of life. , 2005, Functional neurology.

[23]  Katy Mitchell,et al.  Gait and step training to reduce falls in Parkinson's disease. , 2005, NeuroRehabilitation.

[24]  G. Kwakkel,et al.  Efficacy of a physical therapy program in patients with Parkinson's disease: a randomized controlled trial. , 2005, Archives of physical medicine and rehabilitation.

[25]  Peter Herbison,et al.  Statistical analysis of efficacy in falls prevention trials. , 2005, The journals of gerontology. Series A, Biological sciences and medical sciences.

[26]  W. Grobman,et al.  Methods of clinical prediction. , 2006, American journal of obstetrics and gynecology.

[27]  P. Thompson,et al.  Reasons for admission to hospital for Parkinson’s disease , 2006, Internal medicine journal.

[28]  Marjan Jahanshahi,et al.  Caregiver-burden in parkinson's disease is closely associated with psychiatric symptoms, falls, and disability. , 2006, Parkinsonism & related disorders.

[29]  A. Campbell,et al.  Rethinking individual and community fall prevention strategies: a meta-regression comparing single and multifactorial interventions. , 2007, Age and ageing.

[30]  Ann Ashburn,et al.  A meta‐analysis of six prospective studies of falling in Parkinson's disease , 2007, Movement disorders : official journal of the Movement Disorder Society.

[31]  B. Bloem,et al.  Evidence‐based analysis of physical therapy in Parkinson's disease with recommendations for practice and research , 2007, Movement disorders : official journal of the Movement Disorder Society.

[32]  Raija Korpelainen,et al.  Postural sway and falls in Parkinson's disease: A regression approach , 2007, Movement disorders : official journal of the Movement Disorder Society.

[33]  J. Iwamoto,et al.  Risedronate and ergocalciferol prevent hip fracture in elderly men with Parkinson disease [RETRACTED] , 2007, Neurology.

[34]  C. Tanner,et al.  Projected number of people with Parkinson disease in the most populous nations, 2005 through 2030 , 2007, Neurology.

[35]  Claire Ballinger,et al.  A randomised controlled trial of a home based exercise programme to reduce the risk of falling among people with Parkinson’s disease , 2006, Journal of Neurology, Neurosurgery & Psychiatry.

[36]  G. Kwakkel,et al.  Cueing training in the home improves gait-related mobility in Parkinson’s disease: the RESCUE trial , 2007, Journal of Neurology, Neurosurgery & Psychiatry.

[37]  K. Bötzel,et al.  Push and release test predicts better Parkinson fallers and nonfallers than the pull test: Comparison in OFF and ON medication states , 2008, Movement disorders : official journal of the Movement Disorder Society.

[38]  K Bo Foreman,et al.  Collections Tests and Measurements Parkinson Disease and Parkinsonian Disorders Diagnosis / Prognosis : Other in the following collection , 2008 .

[39]  Adrian H. Taylor,et al.  The effectiveness of exercise interventions for people with Parkinson's disease: A systematic review and meta‐analysis , 2008, Movement disorders : official journal of the Movement Disorder Society.

[40]  G. Kwakkel,et al.  Identifying fallers with Parkinson's disease using home‐based tests: Who is at risk? , 2008, Movement disorders : official journal of the Movement Disorder Society.

[41]  M. Morris,et al.  Cost effectiveness of preventing falls and improving mobility in people with Parkinson disease: protocol for an economic evaluation alongside a clinical trial , 2008, BMC geriatrics.

[42]  M. Jahanshahi,et al.  Quality of life in Parkinson's disease: The relative importance of the symptoms , 2008, Movement disorders : official journal of the Movement Disorder Society.

[43]  C. Hui-Chan,et al.  Cued task‐specific training is better than exercise in improving sit‐to‐stand in patients with Parkinson's disease: A randomized controlled trial , 2008, Movement disorders : official journal of the Movement Disorder Society.

[44]  D J Burn,et al.  Impaired attention predicts falling in Parkinson's disease. , 2009, Parkinsonism & related disorders.

[45]  M. Pang,et al.  Fear of falling is independently associated with recurrent falls in patients with Parkinson’s disease: a 1-year prospective study , 2009, Journal of Neurology.

[46]  Stephen R Lord,et al.  Clinical and physiological assessments for elucidating falls risk in Parkinson's disease , 2009, Movement disorders : official journal of the Movement Disorder Society.

[47]  H. Yatsuya,et al.  Group Education with Personal Rehabilitation for Idiopathic Parkinson's Disease , 2009, Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques.

[48]  Roberto Maestri,et al.  Rehabilitation treatment of gait in patients with Parkinson's disease with freezing: A comparison between two physical therapy protocols using visual and auditory cues with or without treadmill training , 2009, Movement disorders : official journal of the Movement Disorder Society.

[49]  Hylton B Menz,et al.  Acceleration patterns of the head and pelvis during gait in older people with Parkinson's disease: a comparison of fallers and nonfallers. , 2009, The journals of gerontology. Series A, Biological sciences and medical sciences.

[50]  Susan M Murray,et al.  Exercise therapy for prevention of falls in people with Parkinson's disease: A protocol for a randomised controlled trial and economic evaluation , 2009, BMC neurology.

[51]  N. Kumar,et al.  The Sydney Multicenter Study of Parkinson's Disease: The Inevitability of Dementia at 20 years , 2009 .

[52]  M. Pang,et al.  Balance confidence and functional mobility are independently associated with falls in people with Parkinson’s disease , 2009, Journal of Neurology.

[53]  Andreas Kupsch,et al.  Erratum: Comparing exercie in Parkinson's disease—The Berlin LSVT®BIG study , 2010 .

[54]  Eva Negri,et al.  Risk Factors for Falls in Community-dwelling Older People: A Systematic Review and Meta-analysis , 2010, Epidemiology.

[55]  Jeffrey M. Hausdorff,et al.  Wearable Assistant for Parkinson’s Disease Patients With the Freezing of Gait Symptom , 2010, IEEE Transactions on Information Technology in Biomedicine.

[56]  Natalie E. Allen,et al.  The effects of an exercise program on fall risk factors in people with Parkinson's disease: A randomized controlled trial , 2010, Movement disorders : official journal of the Movement Disorder Society.

[57]  R. Camicioli,et al.  Relationship between mild cognitive impairment and falls in older people with and without Parkinson's disease: 1-Year Prospective Cohort Study. , 2010, Gait & posture.

[58]  M H Cole,et al.  Predictors of future falls in Parkinson disease , 2010, Neurology.

[59]  V. Fung,et al.  Reduced muscle power is associated with slower walking velocity and falls in people with Parkinson's disease. , 2010, Parkinsonism & related disorders.

[60]  Yea-Ru Yang,et al.  Downhill Walking Training in Individuals with Parkinson's Disease: A Randomized Controlled Trial , 2010, American journal of physical medicine & rehabilitation.

[61]  Henry Brodaty,et al.  Determinants of disparities between perceived and physiological risk of falling among elderly people: cohort study , 2010, BMJ : British Medical Journal.

[62]  G. Kwakkel,et al.  Does Cueing Training Improve Physical Activity in Patients With Parkinson’s Disease? , 2010, Neurorehabilitation and neural repair.

[63]  Jeffrey M. Hausdorff,et al.  A Wearable System to Assist Walking of Parkinson´s Disease Patients , 2009, Methods of Information in Medicine.

[64]  G. Kerr,et al.  Falls in Parkinson's disease: Kinematic evidence for impaired head and trunk control , 2010, Movement disorders : official journal of the Movement Disorder Society.

[65]  M. Pang,et al.  Parkinsonian single fallers versus recurrent fallers: different fall characteristics and clinical features , 2010, Journal of Neurology.

[66]  Nicola Smania,et al.  Effect of Balance Training on Postural Instability in Patients With Idiopathic Parkinson’s Disease , 2010, Neurorehabilitation and neural repair.

[67]  J. Friedman,et al.  Falls and the falls efficacy scale in Parkinson’s disease , 2010, Journal of Neurology.

[68]  F. Horak,et al.  Effects of a central cholinesterase inhibitor on reducing falls in Parkinson disease , 2010, Neurology.

[69]  F. Horak,et al.  A meta-regression of the long-term effects of deep brain stimulation on balance and gait in PD , 2010, Neurology.

[70]  M. Morris,et al.  Falls and mobility in Parkinson's disease: protocol for a randomised controlled clinical trial , 2011, BMC neurology.

[71]  M. Jahanshahi,et al.  On the Nature of Fear of Falling in Parkinson’s Disease , 2011, Behavioural neurology.

[72]  P. Ewings,et al.  An exercise intervention to prevent falls in people with Parkinson's disease: a pragmatic randomised controlled trial , 2011, Journal of Neurology, Neurosurgery & Psychiatry.

[73]  M. Kaps,et al.  Effects of a Flexibility and Relaxation Programme, Walking, and Nordic Walking on Parkinson's Disease , 2011, Journal of aging research.

[74]  Catherine Sherrington,et al.  Balance and falls in Parkinson's disease: A meta‐analysis of the effect of exercise and motor training , 2011, Movement disorders : official journal of the Movement Disorder Society.

[75]  Àngels Bayés,et al.  Blind randomized controlled study of the efficacy of cognitive training in Parkinson's disease , 2011, Movement disorders : official journal of the Movement Disorder Society.

[76]  J. Iwamoto,et al.  Amelioration of osteoporosis and hypovitaminosis D by sunlight exposure in Parkinson's disease. , 2011, Parkinsonism & related disorders.

[77]  J. Korpelainen,et al.  Recurrent falls and mortality in Parkinson’s disease: a prospective two‐year follow‐up study , 2011, Acta neurologica Scandinavica.

[78]  K. Foreman,et al.  Testing balance and fall risk in persons with Parkinson disease, an argument for ecologically valid testing. , 2011, Parkinsonism & related disorders.

[79]  J. Iwamoto,et al.  Once-weekly risedronate for prevention of hip fracture in women with Parkinson's disease: a randomised controlled trial , 2011, Journal of Neurology, Neurosurgery & Psychiatry.

[80]  Meir Plotnik,et al.  Postural instability and fall risk in Parkinson’s disease: impaired dual tasking, pacing, and bilateral coordination of gait during the “ON” medication state , 2011, Experimental Brain Research.

[81]  Bastiaan R. Bloem,et al.  Assessment of dual tasking has no clinical value for fall prediction in Parkinson’s disease , 2012, Journal of Neurology.

[82]  M. Morris,et al.  Protocol for a home-based integrated physical therapy program to reduce falls and improve mobility in people with Parkinson’s disease , 2012, BMC Neurology.

[83]  K. Bo Foreman,et al.  Accuracy of Fall Prediction in Parkinson Disease: Six-Month and 12-Month Prospective Analyses , 2011, Parkinson's disease.

[84]  H. Bronte-Stewart,et al.  Effect of medication and STN-DBS on postural control in subjects with Parkinson's disease. , 2012, Parkinsonism & related disorders.

[85]  Catherine Sackley,et al.  Physiotherapy intervention in Parkinson’s disease: systematic review and meta-analysis , 2012, BMJ : British Medical Journal.

[86]  G. Sammer,et al.  Efficacy of a Multimodal Cognitive Rehabilitation Including Psychomotor and Endurance Training in Parkinson's Disease , 2012, Journal of aging research.

[87]  Ryan P. Duncan,et al.  Randomized Controlled Trial of Community-Based Dancing to Modify Disease Progression in Parkinson Disease , 2012, Neurorehabilitation and neural repair.

[88]  Sarah E Lamb,et al.  Interventions for preventing falls in older people living in the community. , 2012, The Cochrane database of systematic reviews.

[89]  M. Aminoff,et al.  Fall frequency and risk assessment in early Parkinson's disease. , 2012, Parkinsonism & related disorders.

[90]  F. Grandas,et al.  Risk of Falls in Parkinson's Disease: A Cross-Sectional Study of 160 Patients , 2012, Parkinson's disease.

[91]  N. Smania,et al.  Does robotic gait training improve balance in Parkinson's disease? A randomized controlled trial. , 2012, Parkinsonism & related disorders.

[92]  S. Adams,et al.  Clinical prediction rules , 2012, BMJ : British Medical Journal.

[93]  Bridget Farham,et al.  Tai Chi and postural stability in patients with Parkinson’s disease , 2012 .

[94]  Jean-Francois Esculier,et al.  Home-based balance training programme using Wii Fit with balance board for Parkinsons's disease: a pilot study. , 2012, Journal of rehabilitation medicine.

[95]  Hylton B. Menz,et al.  Determinants of health-related quality of life in people with Parkinson’s disease: a path analysis , 2013, Quality of Life Research.

[96]  Victoria A Goodwin,et al.  An exercise intervention to prevent falls in Parkinson’s: an economic evaluation , 2012, BMC Health Services Research.

[97]  W. P. van den Wildenberg,et al.  Differential susceptibility to motor impulsivity among functional subtypes of Parkinson's disease , 2012, Journal of Neurology, Neurosurgery & Psychiatry.

[98]  Rebecca Stowe,et al.  Physiotherapy versus placebo or no intervention in Parkinson's disease. , 2012, The Cochrane database of systematic reviews.

[99]  G. Kwakkel,et al.  Rehabilitation, exercise therapy and music in patients with Parkinson's disease: a meta-analysis of the effects of music-based movement therapy on walking ability, balance and quality of life. , 2012, Parkinsonism & related disorders.

[100]  S. Lord,et al.  Increased concern is protective for falls in Chinese older people: the chopstix fall risk study. , 2013, The journals of gerontology. Series A, Biological sciences and medical sciences.

[101]  H. Krüger Exercise for People in Early- or Mid-Stage Parkinson Disease: A 16-Month Randomized Controlled Trial , 2013 .

[102]  B. Bloem,et al.  Quantitative wearable sensors for objective assessment of Parkinson's disease , 2013, Movement disorders : official journal of the Movement Disorder Society.

[103]  Linda Clare,et al.  Nonpharmacological enhancement of cognitive function in Parkinson's disease: A systematic review , 2013, Movement disorders : official journal of the Movement Disorder Society.

[104]  A. Mirelman,et al.  V-TIME: a treadmill training program augmented by virtual reality to decrease fall risk in older adults: study design of a randomized controlled trial , 2013, BMC Neurology.

[105]  Nir Giladi,et al.  Falls in Parkinson disease: analysis of a large cross-sectional cohort. , 2013, Journal of Parkinson's disease.

[106]  F. Backx,et al.  Promotion of physical activity and fitness in sedentary patients with Parkinson’s disease: randomised controlled trial , 2013, BMJ.

[107]  Natalie E. Allen,et al.  Recurrent Falls in Parkinson's Disease: A Systematic Review , 2013, Parkinson's disease.

[108]  Aline A Scianni,et al.  Progressive resistance exercise improves strength and physical performance in people with mild to moderate Parkinson's disease: a systematic review. , 2013, Journal of physiotherapy.

[109]  K. Aminian,et al.  Fall detection with body-worn sensors , 2013, Zeitschrift für Gerontologie und Geriatrie.

[110]  A. Campbell,et al.  Fall Prevention: Single or Multiple Interventions? Single Interventions for Fall Prevention , 2013, Journal of the American Geriatrics Society.

[111]  Catherine Sherrington,et al.  Three simple clinical tests to accurately predict falls in people with Parkinson's disease , 2013, Movement disorders : official journal of the Movement Disorder Society.

[112]  Mark V Albert,et al.  Wii Fit Balance Board Playing Improves Balance and Gait in Parkinson Disease , 2013, PM & R : the journal of injury, function, and rehabilitation.

[113]  R. Walker,et al.  Hip fractures in people with idiopathic Parkinson's disease: Incidence and outcomes , 2013, Movement disorders : official journal of the Movement Disorder Society.

[114]  Ellen Poliakoff,et al.  The effect of gym training on multiple outcomes in Parkinson's disease: a pilot randomised waiting-list controlled trial. , 2013, NeuroRehabilitation.

[115]  Colum D Mackinnon New strides in wearable sensor technology , 2013, Movement disorders : official journal of the Movement Disorder Society.

[116]  Nicola Smania,et al.  Robot-assisted gait training versus equal intensity treadmill training in patients with mild to moderate Parkinson's disease: a randomized controlled trial. , 2013, Parkinsonism & related disorders.

[117]  V. Fung,et al.  The Relative Contribution of Physical and Cognitive Fall Risk Factors in People With Parkinson’s Disease , 2014, Neurorehabilitation and neural repair.

[118]  Catherine Sherrington,et al.  Leg muscle power is enhanced by training in people with Parkinson’s disease: a randomized controlled trial , 2014, Clinical rehabilitation.

[119]  J. Mehrholz,et al.  Treadmill training for patients with Parkinson's disease. , 2015, The Cochrane database of systematic reviews.

[120]  B. Bloem,et al.  Interventions for preventing falls in Parkinson's disease , 2015 .

[121]  J. Iwamoto,et al.  Retracted: Amelioration of osteoporosis and hypovitaminosis D by sunlight exposure in Parkinson's disease. , 2016, Parkinsonism & related disorders.