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Abstract

Background The correct identification of patients with Parkinson's disease (PD) at risk of falling is important to early initiate appropriate treatment.

Objective This study compares the Fullerton Advanced Balance (FAB) scale with the Mini Balance Evaluation Systems Test (Mini-BESTest) and Berg Balance Scale (BBS) to identify individuals with PD at risk for falls and to analyze which of the items of the scales best predict future falls.

Design Prospective study to assess predictive criterion-related validity.

Setting University hospital in an urban community.

Patients 85 patients with idiopathic PD (Hoehn & Yahr stage: 1-4).

Measurements Number of falls (assessed prospectively over 6 months), FAB scale, Mini-BESTest, BBS and Unified Parkinson's Disease Rating Scale.

Results The FAB scale, Mini-BESTest and BBS had an accuracy to predict future falls of 0.68, 0.65 and 0.69 of the area under the curve (AUC) of the receiver operating characteristic (ROC) curve, respectively. A model combining the items “tandem stance”, “rise to toes”, “one leg stance”, “compensatory stepping backward”, “turning” and “placing alternate foot on stool” had an AUC of 0.84 of the ROC curve.

Limitations Drop-out rate of 19 subjects.

Conclusions The FAB scale, Mini-BESTest and BBS provide moderate capacity to predict fallers with one or more falls from non-fallers. Only some items of the three scales contribute to the detection of future falls. Clinicians should particularly focus on the items “tandem stance” in addition with the items “one leg stance”, “rise to toes”, “compensatory stepping backward”, “turning 360°” and “placing foot on stool” when analyzing postural control deficits related to fall risk. Future research should analyze if balance training including the aforementioned items is effective to reduce fall risk.