A meta‐analysis of six prospective studies of falling in Parkinson's disease
Identifieur interne : 000176 ( Istex/Corpus ); précédent : 000175; suivant : 000177A meta‐analysis of six prospective studies of falling in Parkinson's disease
Auteurs : Ruth M. Pickering ; Yvette A. M. Grimbergen ; Una Rigney ; Ann Ashburn ; Gordon Mazibrada ; Brian Wood ; Peggy Gray ; Graham Kerr ; Bastiaan R. BloemSource :
- Movement Disorders [ 0885-3185 ] ; 2007-10-15.
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Abstract
Recurrent falls are a disabling feature of Parkinson's disease (PD). We have estimated the incidence of falling over a prospective 3 month follow‐up from a large sample size, identified predictors for falling for PD patients repeated this analysis for patients without prior falls, and examined the risk of falling with increasing disease severity. We pooled six prospective studies of falling in PD (n = 473), and examined the predictive power of variables that were common to most studies. The 3‐month fall rate was 46% (95% confidence interval: 38–54%). Interestingly, even among subjects without prior falls, this fall rate was 21% (12–35%). The best predictor of falling was two or more falls in the previous year (sensitivity 68%; specificity 81%). The risk of falling rose as UPDRS increased, to about a 60% chance of falling for UPDRS values 25 to 35, but remained at this level thereafter with a tendency to taper off towards later disease stages. These results confirm the high frequency of falling in PD, as almost 50% of patients fell during a short period of only 3 months. The strongest predictor of falling was prior falls in the preceding year, but even subjects without any prior falls had a considerable risk of sustaining future falls. Disease severity was not a good predictor of falls, possibly due to the complex U‐shaped relation with falls. Early identification of the very first fall therefore remains difficult, and new prediction methods must be developed. © 2007 Movement Disorder Society
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DOI: 10.1002/mds.21598
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Bloem</name><affiliation><mods:affiliation>Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Movement Disorders</title><title level="j" type="abbrev">Mov. Disord.</title><idno type="ISSN">0885-3185</idno><idno type="eISSN">1531-8257</idno><imprint><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><pubPlace>Hoboken</pubPlace><date type="published" when="2007-10-15">2007-10-15</date><biblScope unit="vol">22</biblScope><biblScope unit="issue">13</biblScope><biblScope unit="page" from="1892">1892</biblScope><biblScope unit="page" to="1900">1900</biblScope></imprint><idno type="ISSN">0885-3185</idno></series><idno type="istex">BF88071607F5791BA86FE37931E4D38925D8DD8E</idno><idno type="DOI">10.1002/mds.21598</idno><idno type="ArticleID">MDS21598</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0885-3185</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Parkinson's disease</term><term>UPDRS</term><term>falling</term><term>meta‐analysis</term><term>prediction</term><term>sensitivity</term><term>specificity</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Recurrent falls are a disabling feature of Parkinson's disease (PD). We have estimated the incidence of falling over a prospective 3 month follow‐up from a large sample size, identified predictors for falling for PD patients repeated this analysis for patients without prior falls, and examined the risk of falling with increasing disease severity. We pooled six prospective studies of falling in PD (n = 473), and examined the predictive power of variables that were common to most studies. The 3‐month fall rate was 46% (95% confidence interval: 38–54%). Interestingly, even among subjects without prior falls, this fall rate was 21% (12–35%). The best predictor of falling was two or more falls in the previous year (sensitivity 68%; specificity 81%). The risk of falling rose as UPDRS increased, to about a 60% chance of falling for UPDRS values 25 to 35, but remained at this level thereafter with a tendency to taper off towards later disease stages. These results confirm the high frequency of falling in PD, as almost 50% of patients fell during a short period of only 3 months. The strongest predictor of falling was prior falls in the preceding year, but even subjects without any prior falls had a considerable risk of sustaining future falls. Disease severity was not a good predictor of falls, possibly due to the complex U‐shaped relation with falls. Early identification of the very first fall therefore remains difficult, and new prediction methods must be developed. © 2007 Movement Disorder Society</div></front></TEI><istex><corpusName>wiley</corpusName><author><json:item><name>Ruth M. Pickering RM, BSc, MSc, PhD, CStat</name><affiliations><json:string>Public Health Sciences and Medical Statistics, University of Southampton, Southampton, United Kingdom</json:string></affiliations></json:item><json:item><name>Yvette A.M. Grimbergen YAM, MD</name><affiliations><json:string>Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands</json:string></affiliations></json:item><json:item><name>Una Rigney BSc, MSc</name><affiliations><json:string>Public Health Sciences and Medical Statistics, University of Southampton, Southampton, United Kingdom</json:string></affiliations></json:item><json:item><name>Ann Ashburn PhD, MPhil, FCSP</name><affiliations><json:string>Rehabilitation Research Unit, University of Southampton, Southampton, United Kingdom</json:string></affiliations></json:item><json:item><name>Gordon Mazibrada MD</name><affiliations><json:string>Sobell Department for Motor Neurosciences and Movement Disorders, Institute of Neurology, Queen Square, London, United Kingdom</json:string></affiliations></json:item><json:item><name>Brian Wood MBChB, MD, FRCP</name><affiliations><json:string>Northumbria Healthcare, Wansbeck Hospital, Ashington, Northumberland, United Kingdom</json:string></affiliations></json:item><json:item><name>Peggy Gray RN, BScN</name><affiliations><json:string>Parkinson's Clinic, Ottawa, Ontario, Canada</json:string></affiliations></json:item><json:item><name>Graham Kerr BSC, MPhEd, PhD</name><affiliations><json:string>Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia</json:string></affiliations></json:item><json:item><name>Bastiaan R. Bloem MD, PhD</name><affiliations><json:string>Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands</json:string><json:string>Department of Neurology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>falling</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>prediction</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>sensitivity</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>specificity</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Parkinson's disease</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>meta‐analysis</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>UPDRS</value></json:item></subject><language><json:string>eng</json:string></language><abstract>Recurrent falls are a disabling feature of Parkinson's disease (PD). We have estimated the incidence of falling over a prospective 3 month follow‐up from a large sample size, identified predictors for falling for PD patients repeated this analysis for patients without prior falls, and examined the risk of falling with increasing disease severity. We pooled six prospective studies of falling in PD (n = 473), and examined the predictive power of variables that were common to most studies. The 3‐month fall rate was 46% (95% confidence interval: 38–54%). Interestingly, even among subjects without prior falls, this fall rate was 21% (12–35%). The best predictor of falling was two or more falls in the previous year (sensitivity 68%; specificity 81%). The risk of falling rose as UPDRS increased, to about a 60% chance of falling for UPDRS values 25 to 35, but remained at this level thereafter with a tendency to taper off towards later disease stages. These results confirm the high frequency of falling in PD, as almost 50% of patients fell during a short period of only 3 months. The strongest predictor of falling was prior falls in the preceding year, but even subjects without any prior falls had a considerable risk of sustaining future falls. Disease severity was not a good predictor of falls, possibly due to the complex U‐shaped relation with falls. Early identification of the very first fall therefore remains difficult, and new prediction methods must be developed. © 2007 Movement Disorder Society</abstract><qualityIndicators><score>7.964</score><pdfVersion>1.3</pdfVersion><pdfPageSize>594 x 792 pts</pdfPageSize><refBibsNative>true</refBibsNative><abstractCharCount>1516</abstractCharCount><pdfWordCount>5470</pdfWordCount><pdfCharCount>34179</pdfCharCount><pdfPageCount>9</pdfPageCount><abstractWordCount>247</abstractWordCount></qualityIndicators><title>A meta‐analysis of six prospective studies of falling in Parkinson's disease</title><genre><json:string>Serial article</json:string></genre><host><volume>22</volume><pages><total>9</total><last>1900</last><first>1892</first></pages><issn><json:string>0885-3185</json:string></issn><issue>13</issue><subject><json:item><value>Research Article</value></json:item></subject><genre></genre><language><json:string>unknown</json:string></language><title>Movement Disorders</title><doi><json:string>10.1002/(ISSN)1531-8257</json:string></doi></host><publicationDate>2007</publicationDate><copyrightDate>2007</copyrightDate><doi><json:string>10.1002/mds.21598</json:string></doi><id>BF88071607F5791BA86FE37931E4D38925D8DD8E</id><fulltext><json:item><original>true</original><mimetype>application/pdf</mimetype><extension>pdf</extension><uri>https://api.istex.fr/document/BF88071607F5791BA86FE37931E4D38925D8DD8E/fulltext/pdf</uri></json:item><json:item><original>false</original><mimetype>application/zip</mimetype><extension>zip</extension><uri>https://api.istex.fr/document/BF88071607F5791BA86FE37931E4D38925D8DD8E/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/BF88071607F5791BA86FE37931E4D38925D8DD8E/fulltext/tei"><teiHeader type="text"><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">A meta‐analysis of six prospective studies of falling in Parkinson's disease</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><pubPlace>Hoboken</pubPlace><availability><p>Wiley Subscription Services, Inc., A Wiley Company</p></availability><date>2007</date></publicationStmt><notesStmt><note type="content">*Complete list of authors who contributed to the individual studies: Leiden: Bloem BR, Grimbergen YA, Cramer M, Willemsen MD, Zwinderman AH; London: Bloem BR, Munneke M, Mazibrada G, Schrag A, Viswanathan R, Lees AJ; Southampton: Ashburn A, Stack E, Pickering R, Ward C.; North Tyneside: Wood BH, Bilclough JA, Bowron A, Walker R.; Ottawa: Gray P, Hildebrand K.; Brisbane: Kerr GK, Worringham CJ, Silburn P.</note><note>Prinses Beatrix Fonds</note><note>ZonMw VIDI - No. 016.076.352;</note><note>Parkinson's Queensland</note><note>Queensland University of Technology</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">A meta‐analysis of six prospective studies of falling in Parkinson's disease</title><author><persName><forename type="first">Ruth M.</forename><surname>Pickering</surname><roleName type="degree">RM, BSc, MSc, PhD, CStat</roleName></persName><affiliation>Public Health Sciences and Medical Statistics, University of Southampton, Southampton, United Kingdom</affiliation></author><author><persName><forename type="first">Yvette A.M.</forename><surname>Grimbergen</surname><roleName type="degree">YAM, MD</roleName></persName><affiliation>Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands</affiliation></author><author><persName><forename type="first">Una</forename><surname>Rigney</surname><roleName type="degree">BSc, MSc</roleName></persName><affiliation>Public Health Sciences and Medical Statistics, University of Southampton, Southampton, United Kingdom</affiliation></author><author><persName><forename type="first">Ann</forename><surname>Ashburn</surname><roleName type="degree">PhD, MPhil, FCSP</roleName></persName><affiliation>Rehabilitation Research Unit, University of Southampton, Southampton, United Kingdom</affiliation></author><author><persName><forename type="first">Gordon</forename><surname>Mazibrada</surname><roleName type="degree">MD</roleName></persName><affiliation>Sobell Department for Motor Neurosciences and Movement Disorders, Institute of Neurology, Queen Square, London, United Kingdom</affiliation></author><author><persName><forename type="first">Brian</forename><surname>Wood</surname><roleName type="degree">MBChB, MD, FRCP</roleName></persName><affiliation>Northumbria Healthcare, Wansbeck Hospital, Ashington, Northumberland, United Kingdom</affiliation></author><author><persName><forename type="first">Peggy</forename><surname>Gray</surname><roleName type="degree">RN, BScN</roleName></persName><affiliation>Parkinson's Clinic, Ottawa, Ontario, Canada</affiliation></author><author><persName><forename type="first">Graham</forename><surname>Kerr</surname><roleName type="degree">BSC, MPhEd, PhD</roleName></persName><affiliation>Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia</affiliation></author><author><persName><forename type="first">Bastiaan R.</forename><surname>Bloem</surname><roleName type="degree">MD, PhD</roleName></persName><note type="correspondence"><p>Correspondence: Parkinson Center Nijmegen (ParC), Department of Neurology, 935, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands</p></note><affiliation>Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands</affiliation><affiliation>Department of Neurology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands</affiliation></author></analytic><monogr><title level="j">Movement Disorders</title><title level="j" type="abbrev">Mov. 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We have estimated the incidence of falling over a prospective 3 month follow‐up from a large sample size, identified predictors for falling for PD patients repeated this analysis for patients without prior falls, and examined the risk of falling with increasing disease severity. We pooled six prospective studies of falling in PD (n = 473), and examined the predictive power of variables that were common to most studies. The 3‐month fall rate was 46% (95% confidence interval: 38–54%). Interestingly, even among subjects without prior falls, this fall rate was 21% (12–35%). The best predictor of falling was two or more falls in the previous year (sensitivity 68%; specificity 81%). The risk of falling rose as UPDRS increased, to about a 60% chance of falling for UPDRS values 25 to 35, but remained at this level thereafter with a tendency to taper off towards later disease stages. These results confirm the high frequency of falling in PD, as almost 50% of patients fell during a short period of only 3 months. The strongest predictor of falling was prior falls in the preceding year, but even subjects without any prior falls had a considerable risk of sustaining future falls. Disease severity was not a good predictor of falls, possibly due to the complex U‐shaped relation with falls. Early identification of the very first fall therefore remains difficult, and new prediction methods must be developed. © 2007 Movement Disorder Society</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>Keywords</head><item><term>falling</term></item><item><term>prediction</term></item><item><term>sensitivity</term></item><item><term>specificity</term></item><item><term>Parkinson's disease</term></item><item><term>meta‐analysis</term></item><item><term>UPDRS</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>Article category</head><item><term>Research Article</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2007-01-22">Received</change><change when="2007-04-24">Registration</change><change when="2007-10-15">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/BF88071607F5791BA86FE37931E4D38925D8DD8E/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>Wiley Subscription Services, Inc., A Wiley Company</publisherName><publisherLoc>Hoboken</publisherLoc></publisherInfo><doi registered="yes">10.1002/(ISSN)1531-8257</doi><issn type="print">0885-3185</issn><issn type="electronic">1531-8257</issn><idGroup><id type="product" value="MDS"></id></idGroup><titleGroup><title type="main" xml:lang="en" sort="MOVEMENT DISORDERS">Movement Disorders</title><title type="short">Mov. 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href="file:MDS.MDS21598.pdf"></link></linkGroup></publicationMeta><contentMeta><countGroup><count type="figureTotal" number="2"></count><count type="tableTotal" number="4"></count><count type="referenceTotal" number="30"></count><count type="wordTotal" number="6573"></count></countGroup><titleGroup><title type="main" xml:lang="en">A meta‐analysis of six prospective studies of falling in Parkinson's disease<link href="#fn1"></link></title><title type="short" xml:lang="en">Falls in Parkinson's Disease</title></titleGroup><creators><creator xml:id="au1" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Ruth M.</givenNames><familyName>Pickering</familyName><degrees>RM, BSc, MSc, PhD, CStat</degrees></personName></creator><creator xml:id="au2" creatorRole="author" affiliationRef="#af2"><personName><givenNames>Yvette A.M.</givenNames><familyName>Grimbergen</familyName><degrees>YAM, MD</degrees></personName></creator><creator xml:id="au3" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Una</givenNames><familyName>Rigney</familyName><degrees>BSc, MSc</degrees></personName></creator><creator xml:id="au4" creatorRole="author" affiliationRef="#af3"><personName><givenNames>Ann</givenNames><familyName>Ashburn</familyName><degrees>PhD, MPhil, FCSP</degrees></personName></creator><creator xml:id="au5" creatorRole="author" affiliationRef="#af4"><personName><givenNames>Gordon</givenNames><familyName>Mazibrada</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au6" creatorRole="author" affiliationRef="#af5"><personName><givenNames>Brian</givenNames><familyName>Wood</familyName><degrees>MBChB, MD, FRCP</degrees></personName></creator><creator xml:id="au7" creatorRole="author" affiliationRef="#af6"><personName><givenNames>Peggy</givenNames><familyName>Gray</familyName><degrees>RN, BScN</degrees></personName></creator><creator xml:id="au8" creatorRole="author" affiliationRef="#af7"><personName><givenNames>Graham</givenNames><familyName>Kerr</familyName><degrees>BSC, MPhEd, PhD</degrees></personName></creator><creator xml:id="au9" creatorRole="author" affiliationRef="#af2 #af8" corresponding="yes"><personName><givenNames>Bastiaan R.</givenNames><familyName>Bloem</familyName><degrees>MD, PhD</degrees></personName><contactDetails><email>b.bloem@neuro.umcn.nl</email></contactDetails></creator></creators><affiliationGroup><affiliation xml:id="af1" countryCode="GB" type="organization"><unparsedAffiliation>Public Health Sciences and Medical Statistics, University of Southampton, Southampton, United Kingdom</unparsedAffiliation></affiliation><affiliation xml:id="af2" countryCode="NL" type="organization"><unparsedAffiliation>Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands</unparsedAffiliation></affiliation><affiliation xml:id="af3" countryCode="GB" type="organization"><unparsedAffiliation>Rehabilitation Research Unit, University of Southampton, Southampton, United Kingdom</unparsedAffiliation></affiliation><affiliation xml:id="af4" countryCode="GB" type="organization"><unparsedAffiliation>Sobell Department for Motor Neurosciences and Movement Disorders, Institute of Neurology, Queen Square, London, United Kingdom</unparsedAffiliation></affiliation><affiliation xml:id="af5" countryCode="GB" type="organization"><unparsedAffiliation>Northumbria Healthcare, Wansbeck Hospital, Ashington, Northumberland, United Kingdom</unparsedAffiliation></affiliation><affiliation xml:id="af6" countryCode="CA" type="organization"><unparsedAffiliation>Parkinson's Clinic, Ottawa, Ontario, Canada</unparsedAffiliation></affiliation><affiliation xml:id="af7" countryCode="AU" type="organization"><unparsedAffiliation>Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia</unparsedAffiliation></affiliation><affiliation xml:id="af8" countryCode="NL" type="organization"><unparsedAffiliation>Department of Neurology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands</unparsedAffiliation></affiliation></affiliationGroup><keywordGroup xml:lang="en" type="author"><keyword xml:id="kwd1">falling</keyword><keyword xml:id="kwd2">prediction</keyword><keyword xml:id="kwd3">sensitivity</keyword><keyword xml:id="kwd4">specificity</keyword><keyword xml:id="kwd5">Parkinson's disease</keyword><keyword xml:id="kwd6">meta‐analysis</keyword><keyword xml:id="kwd7">UPDRS</keyword></keywordGroup><fundingInfo><fundingAgency>Prinses Beatrix Fonds</fundingAgency></fundingInfo><fundingInfo><fundingAgency>ZonMw VIDI</fundingAgency><fundingNumber>016.076.352</fundingNumber></fundingInfo><fundingInfo><fundingAgency>Parkinson's Queensland</fundingAgency></fundingInfo><fundingInfo><fundingAgency>Queensland University of Technology</fundingAgency></fundingInfo><abstractGroup><abstract type="main" xml:lang="en"><title type="main">Abstract</title><p>Recurrent falls are a disabling feature of Parkinson's disease (PD). We have estimated the incidence of falling over a prospective 3 month follow‐up from a large sample size, identified predictors for falling for PD patients repeated this analysis for patients without prior falls, and examined the risk of falling with increasing disease severity. We pooled six prospective studies of falling in PD (n = 473), and examined the predictive power of variables that were common to most studies. The 3‐month fall rate was 46% (95% confidence interval: 38–54%). Interestingly, even among subjects without prior falls, this fall rate was 21% (12–35%). The best predictor of falling was two or more falls in the previous year (sensitivity 68%; specificity 81%). The risk of falling rose as UPDRS increased, to about a 60% chance of falling for UPDRS values 25 to 35, but remained at this level thereafter with a tendency to taper off towards later disease stages. These results confirm the high frequency of falling in PD, as almost 50% of patients fell during a short period of only 3 months. The strongest predictor of falling was prior falls in the preceding year, but even subjects without any prior falls had a considerable risk of sustaining future falls. Disease severity was not a good predictor of falls, possibly due to the complex U‐shaped relation with falls. Early identification of the very first fall therefore remains difficult, and new prediction methods must be developed. © 2007 Movement Disorder Society</p></abstract></abstractGroup></contentMeta><noteGroup><note xml:id="fn1"><p>Complete list of authors who contributed to the individual studies: Leiden: Bloem BR, Grimbergen YA, Cramer M, Willemsen MD, Zwinderman AH; London: Bloem BR, Munneke M, Mazibrada G, Schrag A, Viswanathan R, Lees AJ; Southampton: Ashburn A, Stack E, Pickering R, Ward C.; North Tyneside: Wood BH, Bilclough JA, Bowron A, Walker R.; Ottawa: Gray P, Hildebrand K.; Brisbane: Kerr GK, Worringham CJ, Silburn P.</p></note></noteGroup></header></component></istex:document></istex:metadataXml><!--Version 0.6 générée le 3-12-2015--><mods version="3.6"><titleInfo lang="en"><title>A meta‐analysis of six prospective studies of falling in Parkinson's disease</title></titleInfo><titleInfo type="abbreviated" lang="en"><title>Falls in Parkinson's Disease</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>A meta‐analysis of six prospective studies of falling in Parkinson's disease</title></titleInfo><name type="personal"><namePart type="given">Ruth M.</namePart><namePart type="family">Pickering</namePart><namePart type="termsOfAddress">RM, BSc, MSc, PhD, CStat</namePart><affiliation>Public Health Sciences and Medical Statistics, University of Southampton, Southampton, United Kingdom</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Yvette A.M.</namePart><namePart type="family">Grimbergen</namePart><namePart type="termsOfAddress">YAM, MD</namePart><affiliation>Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Una</namePart><namePart type="family">Rigney</namePart><namePart type="termsOfAddress">BSc, MSc</namePart><affiliation>Public Health Sciences and Medical Statistics, University of Southampton, Southampton, United Kingdom</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Ann</namePart><namePart type="family">Ashburn</namePart><namePart type="termsOfAddress">PhD, MPhil, FCSP</namePart><affiliation>Rehabilitation Research Unit, University of Southampton, Southampton, United Kingdom</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Gordon</namePart><namePart type="family">Mazibrada</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Sobell Department for Motor Neurosciences and Movement Disorders, Institute of Neurology, Queen Square, London, United Kingdom</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Brian</namePart><namePart type="family">Wood</namePart><namePart type="termsOfAddress">MBChB, MD, FRCP</namePart><affiliation>Northumbria Healthcare, Wansbeck Hospital, Ashington, Northumberland, United Kingdom</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Peggy</namePart><namePart type="family">Gray</namePart><namePart type="termsOfAddress">RN, BScN</namePart><affiliation>Parkinson's Clinic, Ottawa, Ontario, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Graham</namePart><namePart type="family">Kerr</namePart><namePart type="termsOfAddress">BSC, MPhEd, PhD</namePart><affiliation>Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Bastiaan R.</namePart><namePart type="family">Bloem</namePart><namePart type="termsOfAddress">MD, PhD</namePart><affiliation>Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands</affiliation><affiliation>Department of Neurology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands</affiliation><description>Correspondence: Parkinson Center Nijmegen (ParC), Department of Neurology, 935, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands</description><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre authority="originalCategForm">article</genre><originInfo><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><place><placeTerm type="text">Hoboken</placeTerm></place><dateIssued encoding="w3cdtf">2007-10-15</dateIssued><dateCaptured encoding="w3cdtf">2007-01-22</dateCaptured><dateValid encoding="w3cdtf">2007-04-24</dateValid><copyrightDate encoding="w3cdtf">2007</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="figures">2</extent><extent unit="tables">4</extent><extent unit="references">30</extent><extent unit="words">6573</extent></physicalDescription><abstract lang="en">Recurrent falls are a disabling feature of Parkinson's disease (PD). We have estimated the incidence of falling over a prospective 3 month follow‐up from a large sample size, identified predictors for falling for PD patients repeated this analysis for patients without prior falls, and examined the risk of falling with increasing disease severity. We pooled six prospective studies of falling in PD (n = 473), and examined the predictive power of variables that were common to most studies. The 3‐month fall rate was 46% (95% confidence interval: 38–54%). Interestingly, even among subjects without prior falls, this fall rate was 21% (12–35%). The best predictor of falling was two or more falls in the previous year (sensitivity 68%; specificity 81%). The risk of falling rose as UPDRS increased, to about a 60% chance of falling for UPDRS values 25 to 35, but remained at this level thereafter with a tendency to taper off towards later disease stages. These results confirm the high frequency of falling in PD, as almost 50% of patients fell during a short period of only 3 months. The strongest predictor of falling was prior falls in the preceding year, but even subjects without any prior falls had a considerable risk of sustaining future falls. Disease severity was not a good predictor of falls, possibly due to the complex U‐shaped relation with falls. Early identification of the very first fall therefore remains difficult, and new prediction methods must be developed. © 2007 Movement Disorder Society</abstract><note type="content">*Complete list of authors who contributed to the individual studies: Leiden: Bloem BR, Grimbergen YA, Cramer M, Willemsen MD, Zwinderman AH; London: Bloem BR, Munneke M, Mazibrada G, Schrag A, Viswanathan R, Lees AJ; Southampton: Ashburn A, Stack E, Pickering R, Ward C.; North Tyneside: Wood BH, Bilclough JA, Bowron A, Walker R.; Ottawa: Gray P, Hildebrand K.; Brisbane: Kerr GK, Worringham CJ, Silburn P.</note><note type="funding">Prinses Beatrix Fonds</note><note type="funding">ZonMw VIDI - No. 016.076.352; </note><note type="funding">Parkinson's Queensland</note><note type="funding">Queensland University of Technology</note><subject lang="en"><genre>Keywords</genre><topic>falling</topic><topic>prediction</topic><topic>sensitivity</topic><topic>specificity</topic><topic>Parkinson's disease</topic><topic>meta‐analysis</topic><topic>UPDRS</topic></subject><relatedItem type="host"><titleInfo><title>Movement Disorders</title></titleInfo><titleInfo type="abbreviated"><title>Mov. Disord.</title></titleInfo><subject><genre>article category</genre><topic>Research Article</topic></subject><identifier type="ISSN">0885-3185</identifier><identifier type="eISSN">1531-8257</identifier><identifier type="DOI">10.1002/(ISSN)1531-8257</identifier><identifier type="PublisherID">MDS</identifier><part><date>2007</date><detail type="volume"><caption>vol.</caption><number>22</number></detail><detail type="issue"><caption>no.</caption><number>13</number></detail><extent unit="pages"><start>1892</start><end>1900</end><total>9</total></extent></part></relatedItem><identifier type="istex">BF88071607F5791BA86FE37931E4D38925D8DD8E</identifier><identifier type="DOI">10.1002/mds.21598</identifier><identifier type="ArticleID">MDS21598</identifier><accessCondition type="use and reproduction" contentType="copyright">Copyright © 2007 Movement Disorder Society</accessCondition><recordInfo><recordOrigin>Wiley Subscription Services, Inc., A Wiley Company</recordOrigin><recordContentSource>WILEY</recordContentSource></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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