Posturography and Risk of Recurrent Falls in Healthy Non-Institutionalized Persons Aged Over 65 Clinical and posturographic correlates of falling in Parkinson's disease. A comparison of four functional tests in discriminating fallers from non-fallers in older people Instrumented Test of Sensory Integration for Balance: A Validation Study The comparative ability of eight functional mobility tests for predicting falls in community-dwelling older people. Validity of the Dynamic Gait Index in People With Multiple Sclerosis Utility of Disease-Specific Measures and Clinical Balance Tests in Prediction of Falls in Persons With Multiple Sclerosis A pilot study to explore the predictive validity of 4 measures of falls risk in frail elderly patients. Comparison of Self-report and Performance-Based Balance Measures for Predicting Recurrent Falls in People With Parkinson Disease: Cohort Study Predicting falls among patients with multiple sclerosis: Comparison of patient-reported outcomes and performance-based measures of lower extremity functions. Objective Assessment of Fall Risk in Parkinson's Disease Using a Body-Fixed Sensor Worn for 3 Days Hip muscle and hand-grip strength to differentiate between older fallers and non-fallers: a cross-sectional validity study Identification of high risk fallers among older people living in residential care facilities: a simple screen based on easily collectable measures. Predicting accidental falls in people with multiple sclerosis — a longitudinal study Risk factors for falls in multiple sclerosis: an observational study External validation of a simple clinical tool used to predict falls in people with Parkinson disease. A prospective evaluation of balance, gait, and strength to predict falling in women with multiple sclerosis. Mobility, Balance and Falls in Persons with Multiple Sclerosis Nutritional Status in Relation to Balance and Falls in the Elderly History and mobility exam index to identify community-dwelling elderly persons at risk of falling. Falls in people with multiple sclerosis who use a walking aid: prevalence, factors, and effect of strength and balance interventions. Case-control study of hazards in the home and risk of falls and hip fractures. Comparative Utility of the BESTest, Mini-BESTest, and Brief-BESTest for Predicting Falls in Individuals With Parkinson Disease: A Cohort Study
Background : A poor postural stability in older people is associated with an increased risk of falling . The posturographic tool has widely been used to assess balance control ; however , its value in predicting falls remains unclear . Objective : The purpose of this prospect i ve study was to determine the predictive value of posturography in the estimation of the risk of recurrent falls , including a comparison with st and ard clinical balance tests , in healthy non-institutionalized persons aged over 65 . Methods : Two hundred and six healthy non-institutionalized volunteers aged over 65 were tested .  Postural control  was evaluated by posturographic tests , performed on static , dynamic and dynamized platforms ( static test , slow dynamic test and Sensory Organization Test [ SOT ] ) and clinical balance tests ( Timed ‘ Up & Go ’ test , One-Leg Balance , Sit-to-St and -test ) .  Subsequent falls were monitored prospect ively with self- question naire sent every 4 months for a period of 16 months after the balance testing . Subjects were classified prospect ively in three groups of Non-Fallers ( 0 fall ) , Single-Fallers ( 1 fall ) and Multi-Fallers ( more than 2 falls ) . Results : Loss of balance during the last trial of the SOT sensory conflicting condition , when visual and somatosensory inputs were distorted , was the best factor to predict the risk of recurrent falls ( OR = 3.6 , 95 % CI = 1.3–10.11 ) . Multi-Fallers showed no postural adaptation during the repetitive trials of this sensory condition , contrary to Non-Fallers and Single-Fallers . The Multi-Fallers showed significantly more sway when visual inputs were occluded . The clinical balance tests , the static test and the slow dynamic test revealed no significant differences between the groups . Conclusion : In a sample of non-institutionalized older persons aged over 65 , posturographic evaluation by the SOT , especially with repetition of the same task in sensory conflicting condition , compared to the clinical tests and the static and dynamic posturographic test , appears to be a more sensitive tool to identify those at high-risk of recurrent falls Various clinical tests and balance scales have been used to assess postural stability and the risk of falling in patients with idiopathic Parkinson 's disease ( IPD ) .  Quantitative posturography allows a more objective assessment but the findings in previous studies have been inconsistent and few studies have investigated which posturographic measures correlate best with a history of falling . The purpose of this study was to determine the efficacy of clinical tests , balance scales , and  stable-platform posturography  in detecting postural instability and discriminating between fallers and non-fallers in a home-dwelling PD cohort . Forty-eight PD subjects ( Hoehn & Yahr stage 1 - 3 ) and 17 age-matched controls had the following assessment s : Activities-specific Balance Confidence scale , Berg Balance Scale , Unified Parkinson 's Disease Rating Scale ( UPDRS ) ( motor ) , pull-test , timed up- and -go , static posturography , and dynamic posturography to assess multidirectional leaning balance . Of the clinical assessment s , all but the pull-test were closely correlated with a history of falling .  Static posturography  discriminated between PD fallers and controls but not between PD fallers and non-fallers , whereas  dynamic posturography ( reaction time , velocity , and target hit-time ) also discriminated between fallers and non-fallers . Our findings suggest that this combination of clinical and posturographic measures would be useful in the prospect i ve assessment of falls risk in PD patients . A further prospect i ve study is now required to assess their predictive value . © 2013 Movement Disorder Society Purpose : Which functional tests on mobility and balance can better screen older people at risk of falls is unclear . This study aims to compare the  Berg Balance Scale ( BBS ) , Tinetti Mobility Score ( TMS ) , Elderly Mobility Scale ( EMS ) and Timed Up and Go test ( TUG )  in discriminating fallers from non-fallers in older people . Method : This was a case-control study involving one rater who conducted a mobility and balance assessment on subjects using the four functional tests in r and om sequence .  Subjects recruited included 17 and 22 older people with a history of single and multiple falls respectively from a public Falls Clinic , and 39 community-dwellers without fall history and whose age , sex and BMI matched those of the fallers . All subjects underwent the mobility and balance assessment within one day . Results : Single fallers performed better than multiple fallers in all four functional tests but were worse than non-fallers in the BBS , TMS and TUG . The BBS demonstrated the best discriminating ability , with high sensitivity and specificity . The BBS item ` pick up an object from the floor ' was the best at screening fallers . Conclusion : BBS was the most powerful functional test of the four in discriminating fallers from non-faller Background and Purpose : Abnormal postural sway is associated with an increase in risk of falls but is difficult for clinicians to accurately quantify without access to laboratory equipment . Instrumenting clinical outcome measures using body-worn movement monitors is a low-cost alternative . This is the first study to compare the modified Clinical Test of Sensory Integration for Balance ( i-mCTSIB ) to the laboratory test of the Sensory Organization Test ( SOT ) with dynamic posturography in a group of participants with Parkinson 's disease ( PD ) and subtle balance limitations . The purpose of this study was to ( 1 ) determine the concurrent validity of the i-mCTSIB with the SOT ( 6 and 4 conditions ) and ( 2 ) compare the i-mCTSIB and the SOT to differentiate between individuals with and without recent falls within the previous 6 months . Methods : This cross-sectional study examined 26 participants with idiopathic PD who had a Motor Unified Parkinson 's Disease Rating Scale score of 32.7 ( 13.5 ) out of 108 . Results : The composite and conditions 1 and 4 of the i-mCTSIB and SOT scores were significantly correlated : composite scores r = −0.64 ( P ⩽ .001 ) , C1 r = −0.43 ( P = .03 ) , C3 r = −0.60 ( P ⩽ .01 ) , and C4 r = −0.54 ( P ⩽ .001 ) . A significant difference was observed in mean i-mCTSIB composite scores between fallers and nonfallers ( P = .04 ) . In contrast , the SOT composite was not significantly different between fallers and nonfallers ( P = 0.31 ) . Discussion : The results suggest that the i-mCTSIB may be a valid and clinical ly meaningful measure of sensory organization in persons with PD , even those with mild postural instability as measured by the median Hoehn and Yahr score ( 2.0 ) . Future research should evaluate predictive validity of the i-mCTSIB for prospect i ve falls . Conclusion : The instrumented mCTSIB with portable , body-worn movement allows clinicians to quantify abnormal postural sway without the ceiling effects of clinical balance testing or the expense and importability of force plate technology in the SOT . Instrumenting mCTSIB may also distinguish between fallers and nonfallers BACKGROUND numerous tests have been suggested as fall risk indicators . However , the validity of these assessment s has not been demonstrated in large representative sample s of community-dwelling older people . OBJECTIVE the objective of this study was to examine the comparative ability and clinical utility of eight mobility tests for predicting multiple falls in older community-dwelling people . METHODS design -- prospect i ve cohort study ; subjects--362 subjects aged 74 - 98 years ; measurements --the sit-to-st and test with one and five repetitions , the pick-up-weight test , the half-turn test , the alternate-step test ( AST ) , the six-metre-walk test ( SMWT )  and  stair ascent and descent tasks . Falls were monitored for 1 year with fall calendars . RESULTS in the 12-month follow-up period , 80 subjects ( 22.1 % ) suffered two or more falls . Multiple fallers performed significantly worse than non-multiple fallers in the sit-to-st and test with five repetitions ( STS-5 ) , the AST , the  half-turn test  , the  SMWT  and the stair-descent test .  When dichotomised using cut-off points from receiver-operated characteristics ( ROC ) curve analyses , these tests demonstrated reasonable sensitivity and specificity in identifying multiple fallers . A principal components analysis identified only one factor underlying the mobility tests . Poor performances in two mobility tests , however , increased the risk of multiple falls more than poor performance in one test alone ( ORs = 3.66 , 95 % CI = 1.44 , 9.27 and 1.61 , 95 % CI = 0.62 , 4.16 respectively ) . CONCLUSIONS the mobility tests appear to be measuring a similar ' mobility ' construct . Based on feasibility and predictive validity , the AST , STS-5 and SMWTs were the best tests Background Evaluation of walking capacity and risk of falls in people with multiple sclerosis often are performed in rehabilitation . The Dynamic Gait Index ( DGI ) evaluates walking during different tasks , but the feasibility in identifying people at risk for falls needs to be further investigated . Objective The objective of this study was to investigate ( 1 ) the construct validity ( known groups , convergent , and discriminant ) of the DGI and ( 2 ) the accuracy of predicting falls and establishing a cutoff point to identify fallers . Design This trial was a multicenter , cross-sectional study . Methods A convenience sample was composed of 81 people with multiple sclerosis with subjective gait and balance impairment who were able to walk 100 m ( comparable to Exp and ed Disability Status Scale 1–6 ) . Mean age of the participants was 49 years ; 76 % were women . The  25-Foot Timed Walk Test , Timed “ Up & Go ” Test , Four Square Step Test , Timed Sit-to-St and Test , MS Walking Scale , Multiple Sclerosis Impact Scale , and self-reported falls during the previous  2 months were used for validation , to establish cutoff points for identifying fallers , and to investigate predictive values . Results Significantly lower DGI scores ( P≤.001 ) were found for participants reporting falls ( n=31 ) . High sensitivity ( 87 % ) in identifying fallers was found , with a cutoff score ≤19 . The positive predictive value was 50 % , and the negative predictive value was 87 % . The positive likelihood ratio was 1.77 , and the negative likelihood ratio was 0.26 . The convergent validity was moderate to strong ( ρ=0.58–0.80 ) , with the highest correlation coefficient found for the 25-Foot Timed Walk Test . Discriminant validity was shown with low correlation for the psychological subscale of the Multiple Sclerosis Impact Scale . Limitations The sample included ambulatory people participating in a r and omized controlled trial investigating balance training . Conclusions The DGI is a valid measure of dynamic balance during walking for ambulatory people with multiple sclerosis . With the cutoff point of ≤19 , sensitivity was high in identifying people at risk of falls Background and Purpose : The sensory and motor deficits associated with multiple sclerosis ( MS ) contribute to falls with the majority of persons with MS falling at least once annually . To appropriately direct treatment , accurate fall prediction measures are needed . In this study of community-dwelling individuals with MS followed for 12 months , we sought to determine frequency of falls , utility of clinical balance tests to predict falls , and accuracy of participants ' retrospective recall of fall events . Methods : Independently ambulatory persons with MS underwent 5 clinical balance tests including Activities-specific Balance Confidence , Berg Balance Scale , Functional Reach , Timed Up and Go , and Dynamic Gait Index , and one disease-specific measure of disability  ( Exp and ed Disability Status Scale ) and then were followed for 1 year . Participants were queried monthly by phone to determine the number of fall events that had occurred . Accuracy of fall prediction was determined by receiver operating characteristic curve analysis and comparison of balance test performance between fallers and nonfallers . Results : Sixty-one percent of the 38 participants were classified as fallers at 12-month follow-up . Only the Berg Balance Scale , Dynamic Gait Index , and the Activities-specific Balance Confidence demonstrated clinical ly useful levels of accuracy . In addition , participants were generally poor in their accurate recall of fall events relative to their monthly fall reports . Discussion and Conclusions : The majority of participants fell during a 1-year prospect i ve follow-up . Only 2 balance performance measures and 1 balance confidence measure accurately distinguished between fallers and nonfallers as well as possessed clinical ly useful levels of sensitivity and specificity . These results also emphasized the inaccuracy of retrospective fall history in an MS sample . Video Abstract available ( see Supplemental Digital Content 1 , http://links.lww.com/JNPT/A55 ) for more insights from the author OBJECTIVES To test the hypothesis that scores on 4 falls risk measures  will differ significantly in patients reporting recurrent falls compared with those who do not ; and to explore the validity of each measure to predict such falls status . DESIGN A convenience sample was tested to establish the sensitivity and specificity of the  Functional Reach Test , Timed Up & Go test , one-leg stance test ( OLST )  , and  balance subsection of the Performance Oriented Mobility Assessment ( B-POMA ) . A 12-month retrospective falls history was used to identify recurrent fallers . SETTING A day hospital for the elderly . PARTICIPANTS Convenience sample of 30 day hospital patients . The inclusion criteria were : ability to rise from a chair and walk 6 m ; no severe cognitive impairment or blindness ; age 65 years or older . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Scores on the 4 tests and retrospective falls histories . RESULTS Scores on the B-POMA and OLST showed significant differences between fallers and nonfallers ( P<.05 ) . An  OLST time of 1.02 seconds or less ( odds ratio [OR]=15.2 ; 95 % confidence interval [ CI ] , 1.72 - 133.95 ) and B-POMA score of 11 or less ( OR=18.5 ; 95 % CI , 2.05 - 167.79 ) were predictive of day hospital patients having a history of recurrent falls . CONCLUSIONS OLST and B-POMA both have potential as screening tools for risk of falls , but this observation requires confirmation in a prospect i ve study Background Balance confidence and fear of falling are factors associated with recurrent falls in people with Parkinson disease ( PD ) . However , the accuracy for predicting falls on the basis of self-report measures has not been widely investigated . Objective The study objectives were : ( 1 ) to compare the accuracy of the  Activities-specific Balance Confidence Scale ( ABC )  and the  Falls Efficacy Scale – International ( FES-I )  with that of the  Berg Balance Scale  ( BBS ) , Dynamic Gait Index  ( DGI ) , Functional Reach Test ( FRT ) , and Timed “ Up & Go ” Test ( TUG ) for predicting recurrent falls in people with PD and ( 2 ) to explore the ability of combinations of up to 3 tests to predict recurrent falls . Design This was a prospect i ve cohort study involving 225 people with PD . Methods Participants were assessed with the  ABC , FES-I , BBS , FRT , TUG , and DGI . Participants who reported 2 or more falls in the 12-month follow-up period were classified as recurrent fallers . Areas under the receiver operating characteristic curves were determined , and the Akaike information criterion was used to select the best predictive model . Results Eighty-four participants ( 37.3 % ) were classified as recurrent fallers . Areas under the receiver operating characteristic curves for the ABC , FES-I , TUG , FRT , DGI , and BBS were 0.73 , 0.74 , 0.72 , 0.74 , 0.76 , and 0.79 , respectively . Two-test models provided additional discriminating ability compared with individual measures and had Akaike information criterion values similar to those of 3-test models , particularly the combination of the BBS with the FES-I. Limitations The lack of an external validation sample was a limitation of this study . Conclusions The ABC and FES-I demonstrated moderate accuracy in predicting recurrent falls and a predictive ability similar to that of performance-based balance measures , especially the FRT and the TUG . Two-test models showed performance similar to that of 3-test models , suggesting that a combination of 2 measures may improve the ability to predict recurrent falls in people with PD . Specifically , the combination of the BBS with the FES-I may be considered BACKGROUND Accurate fall screening tools are needed to identify those multiple sclerosis ( MS ) patients at high risk of falling . The present study aim ed at determining the validity of a series of performance-based measures ( PBMs ) of lower extremity functions and patient-reported outcomes ( PROs ) in predicting falls in a sample of MS patients ( n = 84 ) , who were ambulatory independent . METHODS Patients were assessed using the following PBMs : timed up and go ( TUG ) , timed 25-foot walk ( T25FW ) , cognitive T25FW , 2-min walk ( 2MW ) , and cognitive 2MW . Moreover , a series of valid and reliable PROs were filled in by participants including the activities-specific balance confidence ( ABC ) , 12-item multiple sclerosis walking scale ( MSWS-12 ) , fall efficacy scale international ( FES-I ) , and modified fatigue impact scale ( MFIS ) . The dual task cost ( DTC ) of 2MW and T25FW tests were calculated as a percentage of change in parameters from single to dual task conditions . Participants were classified as none-fallers and fallers ( ⩾1 ) based on their prospect i ve fall occurrence . RESULTS In the present study , 41(49 % ) participants recorded ≥ 1 fall and were classified as fallers . The results of logistic regression analysis revealed that each individual test , except DTC of 2MW and T25FW , significantly predicted future falls . However , considering the area under the curves ( AUCs ) , PROs were more accurate compared to PBMs . In addition , the results of multiple logistic regression with the first two factors extracted from principal component analysis revealed that both factor 1 ( PROs ) and factor 2 ( PBMs ) significantly predicted falls with a greater odds ratio ( OR ) for factor 1 ( factor 1 : P = < 0.0001 , OR = 63.41 ( 6.72 - 597.90 ) ) than factor 2 ( P < 0.05 , OR = 5.03 ( 1.33 - 18.99 ) ) . CONCLUSIONS The results of this study can be used by clinicians to identify and monitor potential fallers in MS patients Background Patients 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 Material s 107 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 . Results The 3 day acceleration derived measures were significantly different in fallers and non-fallers and were significantly correlated with previously vali date d 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 / Significance These 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 Background Hip muscle weakness in older people seems to be an influencing factor of falls . Currently , it is unclear which muscles out of the hip muscle group play an important role in older people . A validating process in the measurement regarding muscle strength related to falls is necessary before answering that question . Objective Firstly , we aim ed to investigate which hip muscle group strength shows an acceptable level of distinction between older adult fallers and non-fallers compared to a predefined external criterion regarding falling . Secondly , we aim ed to compare the same outcomes and questions for h and -grip strength in relation to the same external criterion . Design This study was a cross-sectional validity study . Methods The  maximum voluntary isometric strength ( MVIS ) and the rate of force generation of hip abductors ( ABD ) , adductors , internal and external rotators , extensors , and flexors were measured with a dynamometer fixed to a custom-made frame as well as h and -grip strength with a Martin Vigorimeter in 60 older people aged over 65 years ( 38 females and 22 males ) . Results The area under the curve ( AUC ) and the results of the mean decrease in Gini index assessed by r and om forest approach show that of all the assessed parameters , hip ABD MVIS showed the highest discriminative value regarding the chosen external criterion in older people ( AUC ABD MVIS 0.825 , 95 % confidence interval : 0.712–0.938 ) . Conclusion Results indicate that ABD MVIS is a useful measure to distinguish between older adult fallers and non-fallers regarding the chosen external criterion PURPOSE To develop a simple screen based on easily collectable measures to identify older people living in residential care facilities at high risk of falls . METHODS This prospect i ve study was conducted in seven residential care facilities in the U.K. Residents aged>60 years who were not bedbound or terminally ill participated .  Demographics , medical history , medication use , cognition ( mini mental state examination ( MMSE ) ) , function ( Barthel , balance and sit-to-st and ability ) and behavior ( neuro-psychiatric inventory ( NPI ) and impulsivity ) were recorded at baseline . Falls and injuries were prospect ively recorded over 6 months . Data were analyzed for differences between fallers and non-fallers and significant variables entered into logistic regression analysis . RESULTS Two hundred and forty residents completed the study . In the follow-up period , 50 % fell ≥1 times . Fallers had worse function , cognition , behavior and balance and took more medications . Falling in the past year , walking frame and hypnotic/anxiolytic and anti-depressant medication use were also associated with increased likelihood of falling . Logistic regression identified MMSE<17 , impulsivity score ≥ 2 , st and ing balance score<6 , requiring a walking frame , falling in the previous year and use of antidepressants and hypnotics/anxiolytics as independent and significant predictors of falls . The area under the receiver operating curve ( ROC ) for this model was 0.79 ( 95 % CI 0.73 - 0.84 ) . CONCLUSIONS This tool comprising multi-factorial measures provides a simple way of quantifying the probability with which a care home resident will fall over a 6-month period . The tool may also assist in guiding the development and targeting of interventions to prevent falls in this group Objective : To investigate accidental falls and near fall incidents in people with multiple sclerosis with respect to clinical variables and the predictive values of four tests . Design : A longitudinal , multi-centred cohort study with prospect ively collected falls . Procedures : Self-reported incidents during the three months following a st and ardized test procedure . Subjects : Seventy-six people with multiple sclerosis and an Exp and ed Disability Status Scale score between 3.5 and 6.0 . Main outcome measures : Berg Balance Scale , Timed Up and Go cognitive , Four Square Step Test ( FSST ) and 12-item Multiple Sclerosis Walking Scale . Results : Forty-eight people ( 63 % ) registered 270 falls . Most falls occurred indoors during activities of daily life . We found a correlation of rs=0.57 between near falls and falls , and of rs = 0.82 between registered and retrospectively recalled falls . Fallers and non-fallers differed significantly regarding Exp and ed Disability Status Score ( odds ratio ( OR ) 1.99 , 95 % confidence interval ( CI ) 1.22 ; 3.40 ) , spasticity ( OR 1.14 , CI 1.02 ; 1.31 ) , proprioception ( OR 2.50 , CI 1.36 ; 5.12 ) and use of walking aids ( OR 2.27 , CI 1.23 ; 4.37 ) . Reported use of walking aids both indoors and outdoors increased the odds of falling fivefold while disturbed proprioception increased the odds 2.5—15.6 times depending on severity . The odds of falling were doubled for each degree of increased Exp and ed Disability Status Score and more than doubled for each degree of increased spasticity . The Berg Balance Scale , use of walking aids and Timed Up and Go cognitive best identified fallers ( 73—94 % ) and proprioception , Exp and ed Disability Status Score , 12-item Multiple Sclerosis Walking Scale and Four Square Step Test best identified non-fallers ( 75—93 % ) . Conclusions : In clinical practice , looking at the use of walking aids , investigating proprioception and spasticity , rating Exp and ed Disability Status Score and using Berg Balance Scale or Timed Up and Go cognitive all contribute when identifying fallers Background : People with multiple sclerosis ( MS ) experience frequent falls , which are associated with impairments and limitations to activities and participations . Objective : The objective of this paper is to evaluate falls risk factors using robust clinical measures . Methods : A total of 150 individuals ( confirmed MS diagnosis , Exp and ed Disability Status Scale ( EDSS ) 3.5–6.5 ) were recruited , with 148 participants included in the final analysis . Demographic data were collected and performance assessed in eight predictor measures  ( Physiological Profile Assessment ( PPA ) , Brief Ataxia Rating scale , Ashworth scale ( Ashworth ) , Modified Falls Efficacy scale , Symbol Digit Modalities Test , dual-task interference , lying/st and ing blood pressure , static/dynamic visual acuity )  . Participants prospect ively recorded falls over three months using a daily diary . People were classified as “ fallers ” based on reports of ≥ two falls . Results : A total of 104 participants recorded 672 falls ; 78 ( 52.7 % ) reported ≥ two falls . Continence issues , previous falls history and use of prescribed medications were each associated with increased risk of being a “ faller ” . Ashworth and PPA risk score contributed significantly to a logistic regression model predicting faller/non-faller classification . The reduced model ( Ashworth , PPA , EDSS ) showed fair-to-good predictive ability ( ROC c-statistic 0.73 , sensitivity 70 % , specificity 69 % ) . Conclusion : This study confirms the high prevalence of falls in ambulant people with MS . Important potentially modifiable risk factors are identified , suggesting aspects to target in falls interventions BACKGROUND Assessment of fall risk in an individual with Parkinson disease ( PD ) is a critical yet often time consuming component of patient care . Recently a simple clinical prediction tool based only on fall history in the previous year , freezing of gait in the past month , and gait velocity < 1.1 m/s was developed and accurately predicted future falls in a sample of individuals with PD . METHODS We sought to externally vali date the utility of the tool by administering it to a different cohort of 171 individuals with PD .  Falls were monitored prospect ively for 6 months following predictor assessment . RESULTS The tool accurately discriminated future fallers from non-fallers ( area under the curve [ AUC ] = 0.83 ; 95 % CI 0.76 - 0.89 ) , comparable to the developmental study . CONCLUSION The results vali date d the utility of the tool for allowing clinicians to quickly and accurately identify an individual 's risk of an impending fall OBJECTIVE To identify measures of balance , gait , and strength that predict falls in women with multiple sclerosis ( MS ) . DESIGN This prospect i ve study followed participants for 1 year . SETTING University research laboratories . PARTICIPANTS A convenience sample of women with MS ( N=99 ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Balance was assessed with the  limits of stability ( LOS ) test  and the  Sensory Organization Test .  Peak force , torque , and power of knee flexors and extensors as well as hip abductors and adductors were also measured . Temporal-spatial parameters of gait  were measured by an instrumented walkway system . For 1 year after baseline assessment s , the participants reported their falls . Participants were then classified based on the number of reported falls for use in logistic regression models to predict either people with at least 1 fall or people with at least 2 falls ( recurrent fallers ) . RESULTS A total of 159 falls were reported by 48 % of the participants .  Exp and ed Disability Status Scale scores , leaning forward to the LOS , and st and ing sway within a visually referenced surround significantly predicted people with at least 1 fall as well as recurrent fallers . Stance-phase asymmetries and base-of-support width during gait , as well as the force and power produced during leg extension or flexion additionally predicted recurrent fallers . The models ' overall predictive accuracy ranged from 69 % to 85 % . CONCLUSIONS This prospect i ve study confirmed the prevalence and multifactorial nature of falls in this MS sample . In addition to advancing disease status , impaired forward LOS and visually dependent sway ( as well as gait asymmetries and leg flexor-extensor weakness for recurrent fallers ) predict future falls in women with MS Background There is a lack of information concerning the relation between objective measures of gait and balance and fall history in persons with MS ( PwMS ) . This investigation assessed the relation between demographic , clinical , mobility and balance metrics and falls history in persons with multiple sclerosis ( MS ) . Methods 52 ambulatory persons with MS ( PwMS ) participated in the investigation . All persons provided demographic information including fall history over the last 12 months . Disease status was assessed with Exp and  ed Disability Status Scale ( EDSS ) . Walking speed , coordination , endurance and postural control were quantified with a multidimensional mobility battery . Results Over 51 % of the participants fell in the previous year with 79 % of these people being suffering recurrent falls . Overall , fallers were older , had a greater prevalence of assistive devices use , worse disability , decreased walking endurance , and greater postural sway velocity with eyes closed compared to non-fallers . Additionally , fallers had greater impairment in cerebellar , sensory , pyramidal , and bladder/bowel subscales of the EDSS . Conclusions The current observations suggest that PwMS who are older , more disabled , utilize an assistive device , have decreased walking coordination and endurance and have diminished balance have fallen in the previous year . This suggests that individuals who meet these criteria need to be carefully monitored for future falls . Future research is needed to determine a prospect i ve model of falls specific to PwMS . Additionally , the utility of interventions aim ed at reducing falls and fall risk in PwMS needs to be established Background / Aim : In elderly persons , fall-related injury is a serious public health problem . We investigated the impact of essential nutritional elements on falls in the elderly . Methods : Clinical function , balance , gait and disability tests and health and nutritional status assessment s were performed . All subjects were interviewed regarding the occurrence of falls in the last year . Blood tests for serum vitamin D , folate and B12 were conducted among a r and omly selected sub sample of 54 participants in the same month . Results : One hundred 65- to 91-year-old volunteers participated in the study , and 29 of them fell at least once during the past year .  The depression score was higher ( indicating more depressive symptoms ) among fallers compared with non-fallers ( 4.0 ± 3.2 vs. 2.5 ± 2.3 , respectively ) . The overall function score ( indicating better function ) was marginally higher in non-fallers . Subsequent comparisons between fallers and non-fallers were adjusted for overall function and depression scores . Serum folate  was significantly lower in fallers ( 9.5 ± 7.1 vs. 16.2 ± 6.7 ng/ml , p = 0.02 ) . Dietary intake  was equal in both groups . Correlation analyses indicate a significant association between vitamin D and the functional measurements : timed get up and go ( negative ) , Berg balance test , overall functional score , lower extremity score and limitation score ( positive correlation coefficients ) . Serum folate was highly and negatively associated with the number of falls and with prescribed medications and was the only protective factor against falls in a multivariate analysis . Conclusions : Vitamin D was related to most functional and balance measurements . Serum folate was protective against falls . For every 1 ng/ml increase in serum folate the occurrence of falls decreased by 19 % BACKGROUND Falls are common in community-dwelling elderly persons and are a frequent source of morbidity . Simple indices to prospect ively stratify people into categories at different fall-risk would be useful to health care practitioners . Our goal was to develop a fall-risk index that discriminated between people at high and low risk of falling . METHODS We evaluated the risk of falling over a one-year period in 557 elderly persons ( mean age 81.6 ) living in a retirement community . On the baseline interview , we asked subjects if they had fallen in the previous year and evaluated  risk factors  in six additional conceptual categories . On the follow-up interview one year later , we again asked subjects if they had fallen in the prior year . We evaluated risk factors in the different conceptual categories and used logistic regression to determine the independent predictors of falling over a one-year period . We used these independent predictors to create a fall-risk index . We compared the ability of a prior falls history with other risk factors and with the combination of a falls history and other risk factors to discriminate fallers from nonfallers . RESULTS A fall in the previous year ( OR = 2.42 , 95 % CI = 1.49 - 3.93 ) , a symptom of either balance difficulty or dizziness ( OR = 1.83 , 95 % CI = 1.16 - 2.89 ) , or an abnormal mobility exam ( OR = 2.64 , 95 % CI = 1.64 - 4.26 ) were independent predictors of falling over the subsequent year . These three risk factors together ( c statistic = .71 ) discriminated fallers from nonfallers better than previous history of falls alone ( c statistic = .61 ) or the symptomatic and exam risk factors alone ( c statistic = .68 ) . When combined into a risk index , the three independent risk factors stratify people into groups whose risk for falling over the subsequent year ranges from 10 % to 51 % . CONCLUSION A history of falling over the prior year , a risk factor that can be obtained from a clinical history ( balance difficulty or dizziness ) , and a risk factor that can be obtained from a physical exam ( mobility difficulty ) stratify people into groups at low and high risk of falling over the subsequent year . This risk index may provide a simple method of assessing fall risk in community-dwelling elderly persons . However , it requires validation in other subjects before it can be recommended for widespread use OBJECTIVES To investigate falls prevalence , factors associated with falling , and the effects of balance and strengthening interventions on falls in persons with multiple sclerosis ( MS ) . DESIGN Baseline and posttreatment data from a r and omized controlled trial . SETTING Community . PARTICIPANTS People with MS ( N=111 ) who use bilateral support for gait .  INTERVENTIONS Group and one-on-one physiotherapy . MAIN OUTCOME MEASURES Falls 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 . RESULTS The 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 ) . CONCLUSIONS The 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 importance of environmental hazards in the home as risk factors for falls and fractures is uncertain . A case-control study was conducted , involving people aged 65 years and over referred to an occupational therapy department for home assessment . There were 52 subjects with a recent hip fracture , 43 fallers ( subjects with two or more falls in the past year but no hip fracture ) , and 157 non-fallers ( subjects without hip fracture and with fewer than two falls in the past year ) . Subjects ' homes were assessed for environmental hazards by occupational therapists using a  structured home assessment form comprising 35 potential hazards . Overall , the homes of fallers were no more hazardous than the homes of non-fallers . However , fallers with cognitive impairment had significantly more hazards in their homes than non-fallers with cognitive impairment . A wide range of environmental hazards was associated with hip fractures . Many of the findings of this study could be due to bias inherent in the case-control design . To overcome the inadequacies of observational studies for the investigation of home hazards and falls , r and omized trials are recommended to determine if removing hazards reduces the risk of falls and fractures Background The newly developed Brief – Balance Evaluation System Test ( Brief-BESTest ) may be useful for measuring balance and predicting falls in individuals with Parkinson disease ( PD ) . Objectives The purpose s of this study were : ( 1 ) to describe the balance performance of those with PD using the Brief-BESTest , ( 2 ) to determine the relationships among the scores derived from the 3 versions of the BESTest ( ie , full BESTest , Mini-BESTest , and Brief-BESTest ) , and ( 3 ) to compare the accuracy of the Brief-BESTest with that of the Mini-BESTest and BESTest in identifying recurrent fallers among people with PD . Design This was a prospect i ve cohort study . Methods Eighty participants with PD completed a baseline balance assessment . All participants reported a fall history during the previous 6 months . Fall history was again collected 6 months ( n=51 ) and 12 months ( n=40 ) later . Results At baseline , participants had varying levels of balance impairment , and  Brief-BESTest scores were significantly correlated with  Mini-BESTest  ( r=.94 , P<.001 ) and  BESTest  ( r=.95 , P<.001 ) scores . Six-month retrospective fall prediction accuracy of the Brief-BESTest was moderately high ( area under the curve [AUC]=0.82 , sensitivity=0.76 , and specificity=0.84 ) . Prospect i ve fall prediction accuracy over 6 months was similarly accurate ( AUC=0.88 , sensitivity=0.71 , and specificity=0.87 ) , but was less sensitive over 12 months ( AUC=0.76 , sensitivity=0.53 , and specificity=0.93 ) . Limitations The sample included primarily individuals with mild to moderate PD . Also , there was a moderate dropout rate at 6 and 12 months . Conclusions All versions of the BESTest were reasonably accurate in identifying future recurrent fallers , especially during the 6 months following assessment . Clinicians can reasonably rely on the Brief-BESTest for predicting falls , particularly when time and equipment constraints are of concern
Meta- analysis demonstrated fallers perform significantly worse than non-fallers on all measures analysed except the Timed Up and Go Cognitive ( p < 0.05 ) , but discriminative ability of the measures is commonly not reported .
Of those reported , the Activities-specific Balance Confidence Scale had the highest area under the receiver operating characteristic curve value ( 0.92 ) , but without reporting corresponding measures of clinical utility .
Conclusion : Clinical measures of balance differ significantly between fallers and non-fallers but have poor predictive ability for falls risk in people with multiple sclerosis
Objective : To determine the ability of clinical measures of balance to distinguish fallers from non-fallers and to determine their predictive validity in identifying those at risk of falls .