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PHYS THER
Vol. 88, No. 5, May 2008, p. 679
DOI: 10.2522/ptj.2008.88.5.679.1
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Letters and Responses

On "Diagnosis of fall risk in Parkinson disease..." Dibble et al. Phys Ther. 2008;88:323–332.


Dibble et al1 have addressed an important question regarding the methods used for determining the risk for falling in patients with Parkinson disease. My reason for writing this letter is not to take issue with their methods and findings, but rather to raise a question about some of the terminology that was used. In this article, several terms and phrases were used that link the concept of risk with the concept of diagnosis—for example, "diagnosis of fall risk," "fall risk diagnosis," and "ruling out a diagnosis of fall risk." The question is whether doing so is a good idea.

Let's first take a look at definitions for each of the concepts. According to Fletcher and colleagues in their textbook, Clinical Epidemiology: The Essentials,2 risk is described as "the likelihood that people who are exposed to certain factors (‘risk factors’) will subsequently develop a particular disease," and risk factors are defined as "characteristics that are associated with an increased risk of becoming diseased." The definition of the word "diagnosis" is a bit messy, in part because the word has 2 quite different meanings, 1 referring to the diagnostic process, and the other to the diagnostic label. A common understanding of the connection between the 2 meanings is that (1) the outcome of the diagnostic process might be the assignment of a diagnostic label, and (2) the patient has the disease or condition specified by the label.

Now let's consider the paradox created by some of the wording used in this article. If a diagnosis is attached to a condition that a patient already has, why would we need to consider the risk of developing the condition? If risk is the likelihood of developing a condition, not a condition per se, can it really be said to be diagnosed? The authors of this article note that several other investigators3–6 have "called for alternative means of diagnosing fall risk." Although the authors of the cited articles do suggest that alternative means are needed, none of them uses the word "diagnosis" in conjunction with the process of either quantifying risk or identifying risk factors. Given the "risk" for confusion, perhaps it would be useful to disentangle the concepts of risk and diagnosis by using terms like "identification" and "estimation" when referring to risk factors and risk, respectively, instead of using the word "diagnosis."

Barbara J Norton

BJ Norton, PT, PhD, is Associate Professor for the Program in Physical Therapy, Washington University, in St Louis, Mo


  Footnotes
 
This letter was posted as a Rapid Response on March 14, 2008, at www.ptjournal.org.

References

  1. Dibble LE, Christensen J, Ballard DJ, Foreman KB. Diagnosis of fall risk in Parkinson disease: an analysis of individual and collective clinical balance test in interpretation. Phys Ther. 2008;88:323–332.[Abstract/Free Full Text]
  2. Fletcher RH, Fletcher SW, Wagner EH. Clinical Epidemiology: The Essentials. Philadelphia, Pa: Lippincott Williams & Wilkins; 1996.
  3. Lim LI, van Wegen EE, de Goede CJ, et al. Measuring gait and gait-related activities in Parkinson's patients own home environment: a reliability, responsiveness and feasibility study. Parkinsonism Relat Disord. 2005;11:19–24.[CrossRef][Web of Science][Medline]
  4. Behrman AL, Light KE, Flynn SM, Thigpen MT. Is the functional reach test useful for identifying falls risk among individuals with Parkinson's disease? Arch Phys Med Rehabil. 2002;83:538–542.[CrossRef][Web of Science][Medline]
  5. Jacobs JV, Horak FB, Tran VK, Nutt JG. Multiple balance tests improve the assessment of postural stability in subjects with Parkinson's disease. J Neurol Neurosurg Psychiatry. 2006;77:322–326.[Abstract/Free Full Text]
  6. Pickering RM, Grimbergen YA, Rigney U, et al. A meta-analysis of six prospective studies of falling in Parkinson's disease. Mov Disord. 2007;22:1892–1900.[CrossRef][Medline]

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This Article
Right arrow Extract Freely available
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Rapid Responses are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Norton, B. J
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Norton, B. J
Related Collections
Right arrow Parkinson Disease and Parkinsonian Disorders
Right arrow Diagnosis/Prognosis: Other
Right arrow Tests and Measurements
Social Bookmarking
Add to CiteULike   Add to Complore   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
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