Objective: Our aim is to analyze the fear of falling in patients with PD through both clinical variables and instrumented analysis of movement and gait.

Background: Parkinson’s disease (PD) patients have an increased risk of falling, and fear of falling imposes major limitations in patients functionality and quality of life.

Methods: We have selected subjects who met criteria for idiopathic PD, who were assessed through clinical and gait assessment scales including UPDRS, activity of daily living, Berg balance scale, dynamic gait index, and freezing of gait questionnaire. Fear of falling was quantified thought the Falls Efficacy Scale (FES). Each subjects performed iTUG (instrumented Timed-Up-and-Go) during ON state. The lateralization index (LI) for each variable was calculated by the absolute value of the natural logarithm of the ratio between the left side and right side performance in each measure.

Results: A total of 37 subjects were included. Fear of falling was correlated with severity of the disease, severity of freezing of gait, low scores in the activities of daily living scale, worse performance in gait and balance clinical assessment and more depressive symptoms (UPDRS item 1.3). Subjects with higher fear of falling had lower stride length and velocity and higher lateralization index in shanks range of movement. A multivariate linear regression model, with FES as the dependent variable, yielded stride length as the only iTUG variable associated with FES (coefB=-0.525, p=0.006, R2=19.9%). However, when including clinical variables in the model, only UPDRS- subscale 3 (coefB=0.910, R2=21.9%) and depressive symptoms (coefB=13.8, R2=14%) were significant (p=0.001).

Conclusions: It has been suggested that Fear of falling is associated with severity of motor impairment, depressive symptoms, as well as gait and balance impairment. Moreover, our study suggests it is also associated with lower stride length and velocity, and discrepancy in the range of movement between the left and the right limbs. Possibly these features may also be associated with increased risk of falling, presenting as valuable disease severity and risk markers. However, clinical variables such as depressive symptoms and clinically evaluated motor PD symptoms remained largely accountable for fear of falling variability.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-and-instrumental-gait-analysis-study-of-fear-of-falling-in-parkinsons-disease-patients/