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Diagnosis of Fall Risk in Parkinson Disease: An Analysis of Individual and Collective Clinical Balance Test Interpretation

LE Dibble, PT, PhD, ATC, is Associate Professor (Clinical), Department of Physical Therapy, University of Utah, 520 Wakara Way, Salt Lake City, UT 84108 (USA).
J Christensen, PT, DPT, is Physical Therapist–Sports Medicine Resident, Howard Head Sports Medicine Center, Vail, Colo.
DJ Ballard, PT, DPT, is Instructor (Clinical), Division of Physical Therapy, University of Utah.
KB Foreman, PT, PhD, is Associate Professor, Division of Physical Therapy and Division of Plastic Surgery, University of Utah.

lee.dibble{at}hsc.utah.edu

Background and Purpose: Parkinson disease (PD) results in an increased frequency of falls relative to the frequency in neurologically healthy people. The purpose of this study was to compare the accuracy of PD fall risk diagnosis based on one test with that based on the collective interpretation of multiple tests.

Participants: Seventy people with PD (mean age=73.91 years) participated in this study.

Method: Clinical balance tests were conducted during the initial examinations of people with PD. Validity indices were calculated for individual tests and compared with validity indices calculated for a combination of multiple tests.

Results: Thirty-six participants reported a fall history. Analysis of individual tests revealed broad variations in validity indices, whereas the collective interpretation of multiple tests improved sensitivity and negative likelihood ratios.

Discussion and Conclusion: Collective interpretation of clinical balance tests resulted in fewer false-negative results and more substantial adjustments to the posttest probability of being a "faller" than the interpretation of one test alone. These results should be confirmed in a prospective examination of fall risk in PD.

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