What daily activities increase the risk of falling in Parkinson patients? An analysis of the utility of the ABC-16 scale

Background: Although the strongest predictor of falling in Parkinson's disease is the number of falls in the preceding year, little information is available on what types of daily activities (ADLs) that are associated with a significant fall risk in this population.

Objectives: To determine balance confidence (FOF) in PD patients by utilizing the 16-item Activities-Specific Balance Confidence Scale (ABC-16), and identifying specific activities from this scale that are predictors of future falls.

Methods: 160 patients with PD, and 52 age-matched healthy controls completed the Thai-validated version of the ABC-16. The number of falls during the past month was obtained from both groups.

Results: PD patients reported lower confidence in their ability to maintain balance during ADLs compared to controls (p<0.001) with the lowest confidence score being item 16 (walking on slippery sidewalks). A significant negative correlation was observed between the number of falls in the previous month, and a mean ABC-16 score (r=-0.387, p<0.001). Logistic regression analysis identified the strongest predictor of fall in PD patients was item 9 (getting in/out of car; OR=4.8), followed by item 6 (standing on chair to reach; OR=3.4), and item 3 (picking up slippers from floor; OR=2.6). All of these high-risk activities involve movement in the vertical orientation.

Conclusion: FOF was more common in PD patients than controls. In patients with postural instability and visual impairment, high-risk activities should be minimized, avoided, or performed only under supervision. It is recommended that fall prevention strategies include physical therapy interventions that are targeted at these activities.