scholarly journals Accuracy of Fall Prediction in Parkinson Disease: Six-Month and 12-Month Prospective Analyses

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Ryan P. Duncan ◽  
Abigail L. Leddy ◽  
James T. Cavanaugh ◽  
Leland E. Dibble ◽  
Terry D. Ellis ◽  
...  
Keyword(s):  
Pilot Study ◽  
Parkinson Disease ◽  
Roc Curve ◽  
Fall Risk ◽  
Roc Curves ◽  
Berg Balance Scale ◽  
Likelihood Ratios ◽  
Fall Prediction ◽  
Functional Gait ◽  
Prospective Analyses

Introduction. We analyzed the ability of four balance assessments to predict falls in people with Parkinson Disease (PD) prospectively over six and 12 months.Materials and Methods. The BESTest, Mini-BESTest, Functional Gait Assessment (FGA), and Berg Balance Scale (BBS) were administered to 80 participants with idiopathic PD at baseline. Falls were then tracked for 12 months. Ability of each test to predict falls at six and 12 months was assessed using ROC curves and likelihood ratios (LR).Results. Twenty-seven percent of the sample had fallen at six months, and 32% of the sample had fallen at 12 months. At six months, areas under the ROC curve (AUC) for the tests ranged from 0.8 (FGA) to 0.89 (BESTest) with LR+ of 3.4 (FGA) to 5.8 (BESTest). At 12 months, AUCs ranged from 0.68 (BESTest, BBS) to 0.77 (Mini-BESTest) with LR+ of 1.8 (BESTest) to 2.4 (BBS, FGA).Discussion. The various balance tests were effective in predicting falls at six months. All tests were relatively ineffective at 12 months.Conclusion. This pilot study suggests that people with PD should be assessed biannually for fall risk.

scholarly journals Comparison of the Fullerton Advanced Balance Scale, Mini-BESTest, and Berg Balance Scale to Predict Falls in Parkinson Disease

2016 ◽  
Vol 96 (4) ◽  
pp. 494-501 ◽  
Author(s):  
Christian Schlenstedt ◽  
Stephanie Brombacher ◽  
Gesa Hartwigsen ◽  
Burkhard Weisser ◽  
Bettina Möller ◽  
...  
Keyword(s):  
At Risk ◽  
Parkinson Disease ◽  
Roc Curve ◽  
Fall Risk ◽  
Rating Scale ◽  
Dropout Rate ◽  
Berg Balance Scale ◽  
Correct Identification ◽  
Balance Scale ◽  
Compensatory Stepping

Background The correct identification of patients with Parkinson disease (PD) at risk for falling is important to initiate appropriate treatment early. Objective This study compared 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 This was a prospective study to assess predictive criterion-related validity. Setting The study was conducted at a university hospital in an urban community. Patients Eighty-five patients with idiopathic PD (Hoehn and Yahr stages: 1–4) participated in the study. Measurements Measures were 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 showed similar accuracy to predict future falls, with values for area under the curve (AUC) of the receiver operating characteristic (ROC) curve of 0.68, 0.65, and 0.69, 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 There was a dropout rate of 19/85 participants. Conclusions The FAB scale, Mini-BESTest, and BBS provide moderate capacity to predict “fallers” (people with one or more falls) from “nonfallers.” Only some items of the 3 scales contribute to the detection of future falls. Clinicians should particularly focus on the item “tandem stance” along 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 whether balance training including the aforementioned items is effective in reducing fall risk.

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

2008 ◽  
Vol 88 (3) ◽  
pp. 323-332 ◽  
Author(s):  
Leland E Dibble ◽  
Jesse Christensen ◽  
D James Ballard ◽  
K Bo Foreman
Keyword(s):  
Parkinson Disease ◽  
Fall Risk ◽  
False Negative ◽  
Likelihood Ratios ◽  
Balance Test ◽  
Multiple Tests ◽  
Negative Results ◽  
Balance Tests ◽  
History Analysis ◽  
Validity Indices

Background and PurposeParkinson 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.ParticipantsSeventy people with PD (mean age=73.91 years) participated in this study.MethodClinical 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.ResultsThirty-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 ConclusionCollective 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.

14-3-3η Autoantibodies: Diagnostic Use in Early Rheumatoid Arthritis

2015 ◽  
Vol 42 (9) ◽  
pp. 1587-1594 ◽  
Author(s):  
Walter P. Maksymowych ◽  
Gilles Boire ◽  
Dirkjan van Schaardenburg ◽  
Stephanie Wichuk ◽  
Samina Turk ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Early Rheumatoid Arthritis ◽  
Roc Curve ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Healthy Controls ◽  
Likelihood Ratios ◽  
Roc Curve Analysis ◽  
Diagnostic Use ◽  
Early Ra

Objective.To describe the expression and diagnostic use of 14-3-3η autoantibodies in early rheumatoid arthritis (RA).Methods.14-3-3η autoantibody levels were measured using an electrochemiluminescent multiplexed assay in 500 subjects (114 disease-modifying antirheumatic drug-naive patients with early RA, 135 with established RA, 55 healthy, 70 autoimmune, and 126 other non-RA arthropathy controls). 14-3-3η protein levels were determined in an earlier analysis. Two-tailed Student t tests and Mann-Whitney U tests compared differences among groups. Receiver-operator characteristic (ROC) curves were generated and diagnostic performance was estimated by area under the curve (AUC), as well as specificity, sensitivity, and likelihood ratios (LR) for optimal cutoffs.Results.Median serum 14-3-3η autoantibody concentrations were significantly higher (p < 0.0001) in patients with early RA (525 U/ml) when compared with healthy controls (235 U/ml), disease controls (274 U/ml), autoimmune disease controls (274 U/ml), patients with osteoarthritis (259 U/ml), and all controls (265 U/ml). ROC curve analysis comparing early RA with healthy controls demonstrated a significant (p < 0.0001) AUC of 0.90 (95% CI 0.85–0.95). At an optimal cutoff of ≥ 380 U/ml, the ROC curve yielded a sensitivity of 73%, a specificity of 91%, and a positive LR of 8.0. Adding 14-3-3η autoantibodies to 14-3-3η protein positivity enhanced the identification of patients with early RA from 59% to 90%; addition of 14-3-3η autoantibodies to anticitrullinated protein antibodies (ACPA) and/or rheumatoid factor (RF) increased identification from 72% to 92%. Seventy-two percent of RF- and ACPA-seronegative patients were positive for 14-3-3η autoantibodies.Conclusion.14-3-3η autoantibodies, alone and in combination with the 14-3-3η protein, RF, and/or ACPA identified most patients with early RA.

scholarly journals Use of the Berg Balance Scale for Predicting Multiple Falls in Community-Dwelling Elderly People: A Prospective Study

2008 ◽  
Vol 88 (4) ◽  
pp. 449-459 ◽  
Author(s):  
Susan W Muir ◽  
Katherine Berg ◽  
Bert Chesworth ◽  
Mark Speechley
Keyword(s):  
Older Adults ◽  
High Risk ◽  
Predictive Validity ◽  
Fall Risk ◽  
Berg Balance Scale ◽  
Community Dwelling ◽  
Health Concern ◽  
Likelihood Ratios ◽  
Discriminative Ability ◽  
Balance Scale

Background and Purpose Falls are a significant public health concern for older adults; early identification of people at high risk for falling facilitates the provision of rehabilitation treatment to reduce future fall risk. The objective of this prospective cohort study was to examine the predictive validity of the Berg Balance Scale (BBS) for 3 types of outcomes—any fall (≥1 fall), multiple falls (≥2 falls), and injurious falls—by use of sensitivity, specificity, receiver operating characteristic (ROC) curves, area under the curve, and likelihood ratios. Subjects and Methods A sample of 210 community-dwelling older adults received a comprehensive geriatric assessment at baseline, which included the BBS to measure balance. Data on prospective falls were collected monthly for a year. The predictive validity of the BBS for the identification of future fall risk was evaluated. Results The BBS had good discriminative ability to predict multiple falls when ROC analysis was used. However, the use of the BBS as a dichotomous scale, with a threshold of ≤45, was inadequate for the identification of the majority of people at risk for falling in the future, with sensitivities of 25% and 45% for any fall and for multiple falls, respectively. The use of likelihood ratios, maintaining the BBS as a multilevel scale, demonstrated a gradient of risk across scores, with fall risk increasing as scores decreased. Discussion and Conclusion The use of the BBS as a dichotomous scale to identify people at high risk for falling should be discouraged because it fails to identify the majority of such people. The predictive validity of this scale for multiple falls is superior to that for other types of falls, and the use of likelihood ratios preserves the gradient of risk across the whole range of scores.

Effect of Virtual Reality on Balance in Individuals With Parkinson Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2020 ◽  
Vol 100 (6) ◽  
pp. 933-945 ◽  
Author(s):  
Yi Chen ◽  
Qiang Gao ◽  
Cheng-Qi He ◽  
Rong Bian
Keyword(s):  
Virtual Reality ◽  
Parkinson Disease ◽  
Randomized Controlled Trials ◽  
Berg Balance Scale ◽  
Controlled Trials ◽  
Balance Scale ◽  
Randomized Controlled ◽  
Functional Gait ◽  
Dynamic Gait Index ◽  
Dynamic Gait

Abstract Background Virtual reality (VR) is a frequently used intervention for the rehabilitation of individuals with neurological disorders. Purpose The aims of this review were to identify the short-term effect of VR on balance and to compare it with the effect of active interventions in individuals with Parkinson disease (PD). Data Sources Searches for relevant articles available in English were conducted using the MEDLINE (via PubMed), EMBASE, CENTRAL, CINAHL, PsycINFO, and Physiotherapy Evidence Database databases from inception until March 2019. Study Selection All randomized controlled trials comparing the effect of training with VR and the effect of training without VR on balance in individuals with PD were included. Data Extraction Two authors independently extracted data, assessed the methodological quality, and evaluated the evidence quality of the studies. Data Synthesis Fourteen randomized controlled trials including 574 individuals were eligible for qualitative analyses, and 12 of the studies involving 481 individuals were identified as being eligible for meta-analyses. Compared with active interventions, the use of VR improved the Berg Balance Scale score (mean difference = 1.23; 95% CI = 0.15 to 2.31; I2 = 56%). The Dynamic Gait Index and Functional Gait Assessment results were also significant after the sensitivity analyses (mean difference = 0.69; 95% CI = 0.12 to 1.26; I2 = 0%). Both provided moderate statistical evidence. However, the Timed “Up & Go” Test and the Activities-Specific Balance Confidence Scale did not differ significantly. Limitations Publication bias and diversity in the interventions were the main limitations. Conclusions Existing moderate evidence of the effectiveness of VR with the Berg Balance Scale, Dynamic Gait Index, and Functional Gait Assessment for individuals with PD was promising. Although the differences did not reach the clinically important change threshold, VR was comparable to active interventions and could be considered an adjuvant therapy for balance rehabilitation in individuals with PD.

scholarly journals Using Biofeedback to Reduce Step Length Asymmetry Impairs Dynamic Balance in People Poststroke

2021 ◽  
pp. 154596832110193
Author(s):  
Sungwoo Park ◽  
Chang Liu ◽  
Natalia Sánchez ◽  
Julie K. Tilson ◽  
Sara J. Mulroy ◽  
...  
Keyword(s):  
Angular Momentum ◽  
Sagittal Plane ◽  
Dynamic Balance ◽  
Objective Measure ◽  
Frontal Plane ◽  
Step Length ◽  
Berg Balance Scale ◽  
Whole Body ◽  
Functional Gait ◽  
Full Body

Background People poststroke often walk with a spatiotemporally asymmetric gait, due in part to sensorimotor impairments in the paretic lower extremity. Although reducing asymmetry is a common objective of rehabilitation, the effects of improving symmetry on balance are yet to be determined. Objective We established the concurrent validity of whole-body angular momentum as a measure of balance, and we determined if reducing step length asymmetry would improve balance by decreasing whole-body angular momentum. Methods We performed clinical balance assessments and measured whole-body angular momentum during walking using a full-body marker set in a sample of 36 people with chronic stroke. We then used a biofeedback-based approach to modify step length asymmetry in a subset of 15 of these individuals who had marked asymmetry and we measured the resulting changes in whole-body angular momentum. Results When participants walked without biofeedback, whole-body angular momentum in the sagittal and frontal plane was negatively correlated with scores on the Berg Balance Scale and Functional Gait Assessment supporting the validity of whole-body angular momentum as an objective measure of dynamic balance. We also observed that when participants walked more symmetrically, their whole-body angular momentum in the sagittal plane increased rather than decreased. Conclusions Voluntary reductions of step length asymmetry in people poststroke resulted in reduced measures of dynamic balance. This is consistent with the idea that after stroke, individuals might have an implicit preference not to deviate from their natural asymmetry while walking because it could compromise their balance. Clinical Trials Number: NCT03916562.

scholarly journals Toe Clearance Rehabilitative Slippers for Older Adults With Fall Risk: A Randomized Controlled Trial

2021 ◽  
Vol 12 ◽  
pp. 215145932110291
Author(s):  
Atsuko Satoh ◽  
Yukoh Kudoh ◽  
Sangun Lee ◽  
Masumi Saitoh ◽  
Miwa Miura ◽  
...  
Keyword(s):  
Older Adults ◽  
Fall Risk ◽  
Controlled Trial ◽  
Intervention Group ◽  
Berg Balance Scale ◽  
Control Group ◽  
Mobility Assessment ◽  
Before And After ◽  
Day Services ◽  
And Control

Introduction: To evaluate fall-prevention rehabilitative slippers for use by self-caring, independent older adults. Materials and Methods: This assessor-blinded, randomized, and controlled 1-year study included 59 self-caring, independent participants (49 women) who attended day services. The mean age of participants was 84.0 ± 5.3 years. Participants were randomly selected from 8 nursing homes. We tested slippers top-weighted with a lead bead (200, 300, or 400 g). Intervention group participants walked while wearing the slippers for 10-20 min, 1-3 days/week at the day service center. Fall risk was measured using the Berg Balance Scale and the Tinetti Performance-Oriented Mobility Assessment (POMA) before and at 3-month intervals after the intervention/control phase. Results: After 12 months, the intervention group demonstrated significant improvement. Berg Balance and POMA compared to the control group ( p < .05 p < .01, respectively). Mobility scores improved significantly for both measurements in the intervention group before and after ( p < .01), but the control group had significantly lower scores. Discussion: Overall, falls decreased in the intervention group from 10 to 7, and control group falls increased from 9 to 16 ( p = .02). No adverse events related to the intervention were reported. Conclusions: Rehabilitation training slippers may reduce falls in older adults.

scholarly journals Comparison of Four Ultrasonography-Based Risk Stratification Systems in Thyroid Nodules with Nondiagnostic/Unsatisfactory Cytology: A Real-World Study

Cancers ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 1948
Author(s):  
You-Bin Lee ◽  
Young-Lyun Oh ◽  
Jung-Hee Shin ◽  
Sun-Wook Kim ◽  
Jae-Hoon Chung ◽  
...  
Keyword(s):  
Roc Curve ◽  
Thyroid Nodules ◽  
Positive Likelihood Ratio ◽  
Roc Curves ◽  
The Other ◽  
American Thyroid Association ◽  
Data Systems ◽  
Malignancy Rate ◽  
Line P ◽  
The Eu

We compared American Thyroid Association (ATA) guidelines, Korean (K)-Thyroid Imaging, Reporting and Data Systems (TIRADS), EU-TIRADS, and American College of Radiology (ACR) TIRADS in diagnosing malignancy for thyroid nodules with nondiagnostic/unsatisfactory cytology. Among 1143 nondiagnostic/unsatisfactory aspirations from April 2011 to March 2016, malignancy was detected in 39 of 89 excised nodules. The minimum malignancy rate was 7.82% in EU-TIRADS 5 and 1.87–3.00% in EU-TIRADS 3–4. In the other systems, the minimum malignancy rate was 14.29–16.19% in category 5 and ≤3% in the remaining categories. Although the EU-TIRADS category ≥ 5 exhibited the highest positive likelihood ratio (LR) of only 2.214, category ≥ 5 in the other systems yielded the highest positive LR of >5. Receiver operating characteristic (ROC) curves of all systems to predict malignancy were located statistically above the diagonal nondiscrimination line (P for ROC curve: EU-TIRADS, 0.0022; all others, 0.0001). The areas under the ROC curve (AUCs) were not significantly different among the four systems. The ATA guidelines, K-TIRADS, and ACR TIRADS may be useful to guide management for nondiagnostic/unsatisfactory nodules. The EU-TIRADS, although also useful, exhibited inferior performance in predicting malignancy for nondiagnostic/unsatisfactory nodules in Korea, an iodine-sufficient area.

Poster 120 Modified Berg Balance Scale for Use in Fall Prediction Among Patients with Lumbar Spine Precautions

PM&R ◽  
2014 ◽  
Vol 6 (9) ◽  
pp. S225
Author(s):  
Argy Stampas ◽  
Libi Galmer ◽  
Alexander J. Martinez ◽  
Elizabeth A. Dominick ◽  
Michael V. Gramuglia ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Berg Balance Scale ◽  
Balance Scale ◽  
Fall Prediction

Sensitivity of a modified version of the ‘timed get up and go’ test to predict fall risk in the elderly: A pilot study

2009 ◽  
Vol 49 (1) ◽  
pp. e60-e66 ◽  
Author(s):  
Maria Giné-Garriga ◽  
Míriam Guerra ◽  
Marc Marí-Dell’Olmo ◽  
Carme Martin ◽  
Viswanath B. Unnithan
Keyword(s):  
Pilot Study ◽  
Fall Risk ◽  
The Elderly
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