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PHYS THER
Vol. 88, No. 5, May 2008, pp. 679-680
DOI: 10.2522/ptj.2008.88.5.679.2
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Letters and Responses

Author Response


We appreciate the thoughtful comments of Dr Norton in her reading of our recent article and welcome the opportunity to respond. During the evolution of this research and writing of this manuscript, our research group had many conversations regarding the appropriate terminology to describe the examination of the potential for falls in Parkinson disease (PD). Some of Norton's comments regarding the terminology echoed some of our own conversations. Rather than euphemistically use the terms "identification" or "imbalance," we consciously chose the terms "diagnosis" and "fall risk" in an effort to directly address the problem that we hope can be treated. In response, we wish to acknowledge Dr Norton's concerns but not debate whether "diagnosis" or "fall risk" were appropriate terms, but rather to clarify critical elements for optimal clinical decision making in the management of people with PD and our research agenda toward this end.

When physical therapists examine a person with a progressive neurologic disease such as PD, their mode of practice should encompass traditional tertiary preventive care of the current problems (eg, treating bradykinesia during gait, addressing bed mobility limitations).1 In addition, optimal care should encompass secondary prevention; that is, awareness and treatment of complications of the disease process that are likely to occur in the future (eg, falls).2,3

As with many clinical decisions, in the context of PD, diagnosis or identification of a movement problem amenable to treatment is an imprecise endeavor. In order to provide the appropriate secondary preventive care, physical therapists must have accurate clinical measures to rule in or rule out target conditions that may respond to preventive or risk reduction treatments. Toward this end, our study sought to advocate for critical analysis of clinical balance test choice and interpretation rather than the blind acceptance of an individual test or cutoff score.

Above all concerns regarding terminology, the clinical relevance of being able to accurately apply a label to a patient that directs treatment4 cannot be understated. Without question, further work remains. Prospective confirmation of the accuracy of these tests is needed, as are examinations of the efficacy of fall prevention and fall-risk reduction programs for persons with PD.

Leland E Dibble, K Bo Foreman, D James Ballard and Jesse Christensen

LE Dibble, PT, PhD, ATC, is Associate Professor (Clinical) at the University of Utah, Department of Physical Therapy, Salt Lake City, Utah.


  Footnotes
 
This letter was posted as a Rapid Response on March 28, 2008, at www.ptjournal.org.

References

  1. Morris ME. Movement disorders in people with Parkinson disease: a model for physical therapy. Phys Ther. 2000;80:578–597.[Abstract/Free Full Text]
  2. Bloem BR, Steijns JA, Smits-Engelsman BC. An update on falls. Curr Opin Neurol. 2003;16:15–26.[CrossRef][Web of Science][Medline]
  3. Keus SH, Bloem BR, Hendriks EJ, et al. Practice Recommendations Development Group. Evidence-based analysis of physical therapy in Parkinson's disease with recommendations for practice and research. Mov Disord. 2007;22:451–460.[CrossRef][Web of Science][Medline]
  4. Guide to Physical Therapist Practice. 2nd ed. Alexandria, Va: American Physical Therapy Association; 2003:32–38, 307.

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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 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 Dibble, L. E
Right arrow Articles by Christensen, J.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Dibble, L. E
Right arrow Articles by Christensen, 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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Copyright © 2008 by the American Physical Therapy Association.