Objective: Understand why some people with typical Parkinson’s disease (PwP) show unexpected functional mobility e.g. functional mobility despite the presence of risk factors. Consequently, the following research question will guide the project: Why do some PwP show unexpected functional mobility? What are their protective factors?

Background: Difficulties in developing accurate fall prediction models become visible in clinical work: Despite the presence of risk factors not all PwP do fall. Presumably protective factors may also play an important role.

Method: A longitudinal mixed methods study will triangulate differently, but complementary, data about unexpected functional mobility to develop internally confirmed conclusions. The project builds on the Luxembourg Parkinson’s Study [1], which includes more than 800 PwP.
The project follows five steps:
1. Development and validation of the functional mobility composite score (FMCS) of existing, widely applied, translated, and validated PRO instruments according to the COSMIN study design checklist [2].
2. Systematic Review of protective factors according to the JBI standard [3].
3. Analysis of NCER-PD cohort data by a multiple regression to assess the added statistical value of protective factors in the prediction of functional mobility. Addition of protective factors identified by the systematic review to a model including gait and balance problems.
4. Insights of qualitative analysis and 5. Integration of qualitative and quantitative findings. The quantitative results will be validated by investigating unexpected functional mobility in PwP in a qualitative study combining subjective interviews and objective assessments.

Results: After the FMCS has been developed and validated and the protective factors have been summarized by the systematic review, the qualitative part will provide insights about quantitatively explored protective factors.

Conclusion: We expect the validated FMCS to be a less costly and invasive alternative to physical performance tests. Indeed, we believe significant progress could be achieved in fall research by shifting the focus from the prevention of falls (e.g. risk factors) to the promotion of functional mobility (e.g. protective factors).

References: [1] Hipp G, Vaillant M, Diederich NJ, Roomp K, Satagopam VP, Banda P, Sandt E, Mommaerts K, Schmitz SK, Longhino L, Schweicher A, Hanff AM, Nicolai B, Kolber P, Reiter D, Pavelka L, Binck S, Pauly C, Geffers L, Betsou F, Gantenbein M, Klucken J, Gasser T, Hu MT, Balling R, Kruger R (2018) The Luxembourg Parkinson’s Study: A Comprehensive Approach for Stratification and Early Diagnosis. Front Aging Neurosci 10, 326. [2] Mokkink LB, Prinsen CA, Patrick DL, Alonso J, Bouter LM, Vet HCd, Terwee CB (2019) COSMIN Study Design checklist for Patient-reported outcome measurement instruments. eds. COSMIN [3] Moola S, Munn Z, Tufanaru C, Aromataris E, Sears K, Sfetcu R, Currie M, Lisy K, Qureshi R, Mattis P, Mu P (2017) Chapter 7: Systematic reviews in etiology and risk In Joanna Briggs Institute Reviewer’s Manual, Aromataris E, Munn Z, eds. The Joanna Briggs Institute.

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