Stina Jonasson

Psychometric properties of four fear of falling rating scales in people with Parkinson’s disease

BackgroundFear of falling (FOF) is commonly experienced in people with Parkinson’s disease (PD). It is a predictor of recurrent falls, a barrier to physical exercise, and negatively associated with health-related quality of life. A variety of rating scales exist that assess different aspects of FOF but comprehensive head-to-head comparisons of their psychometric properties in people with PD are lacking. The aim of this study was to evaluate the psychometric properties of four FOF rating scales in people with PD. More specifically, we investigated and compared the scales’ data completeness, scaling assumptions, targeting, and reliability.MethodsThe FOF rating scales were: the Falls Efficacy Scale-International (FES-I), the Swedish FES (FES(S)), the Activities-specific Balance Confidence scale (ABC), and the modified Survey of Activities and Fear of Falling in the Elderly (mSAFFE). A postal survey was administered to 174 persons with PD. Responders received a second survey after two weeks.ResultsThe mean (SD) age and PD duration of the 102 responders were 73 (8) and 7 (6) years, respectively. ABC had worse data completeness than the other scales (6.9 vs. 0.9–1.3% missing data). All scales had corrected item-total correlations exceeding 0.4 and showed acceptable reliabilities (Cronbach’s alpha and Intraclass Correlation Coefficient (ICC) >0.80) but only FES-I had ICC >0.90. The standard error of measurements ranged from 7% (FES-I) to 12% (FES(S)), and the smallest detectable differences ranged from 20% (FES-I) to 33% (FES(S)) of the total score ranges. ABC and FES(S) had substantially more outliers than mSAFFE and FES-I (10 and 15 vs. 3 and 4, respectively) when the two test occasions were compared.ConclusionsWhen assessing FOF in people with PD, the findings in the present study favoured the choice of FES-I or mSAFFE. However, FES-I was the only scale with ICC >0.90 which has been suggested as a minimum when using a scale for individual comparisons.

Concerns about falling in Parkinson’s Disease: Associations with disabilities and personal and environmental factors

BACKGROUND Fear of falling can be conceptualized in different ways, e.g., as concerns about falling or low fall-related self-efficacy. It is common in people with Parkinsons disease (PD), and there is growing knowledge about its contributing factors. However, previous multivariate studies have mainly focused on fear of falling in relation to PD-related disabilities, and less is known about the associations between fear of falling and personal and environmental factors. OBJECTIVE To identify explanatory factors of concerns about falling in people with PD by focusing on personal and environmental factors as well as PD-related disabilities. METHODS Data were collected from 241 persons with PD (39% women, median age 70 years, PD duration 8 years). Concerns about falling (assessed with the Falls Efficacy Scale-International, FES-I; categorized into low, moderate, or high concerns) were used as the dependent variable in a multivariate ordinal regression analysis. Personal factors, environmental factors and PD-related disabilities constituted independent variables. RESULTS Low, moderate and high concerns about falling were reported by 29% , 24% and 47% of the participants, respectively. Walking difficulties, orthostatism, motor symptoms, age, and fatigue (presented in order of importance) were significant (p <  0.05) explanatory factors of concerns about falling. CONCLUSIONS Several factors significantly explained concerns about falling in people with PD. Walking difficulties was by far the strongest explanatory factor. This suggests that minimizing walking difficulties should be a primary target when aiming at reducing concerns about falling in people with PD.

Psychometric properties of the Satisfaction With Life Scale in Parkinson's disease

The Satisfaction With Life Scale (SWLS) is a global measure of life satisfaction (LS). The objective of this study was to evaluate the psychometric properties (data completeness, scaling assumptions, targeting and reliability) of the SWLS in a sample of people with Parkinsons disease (PD).

Mobility device use in people with Parkinson's disease: A 3-year follow-up study.

This study aimed to investigate how the use and perceived unmet need of mobility devices (MD) in people with Parkinsons disease (PD) evolve over a 3‐year period.

Psychometric Evaluation of the Parkinson's Disease Activities of Daily Living Scale

Objective To evaluate a set of psychometric properties (i.e., data completeness, targeting, and external construct validity) of the Parkinsons disease Activities of Daily Living Scale (PADLS) in people with Parkinsons disease (PD). Specific attention was paid to the association between PADLS and PD severity, according to the Hoehn & Yahr (H&Y) staging. Methods The sample included 251 persons with PD (mean age 70 [SD 9] years). Data collection comprised a self-administered postal survey, structured interviews, and clinical assessments at home visits. Results Data completeness was 99.6% and the mean PADLS score was 2.1. Floor and ceiling effects were 22% and 2%, respectively. PADLS scores were more strongly associated (rs > 0.5) with perceived functional independence, ADL dependency, walking difficulties, and self-rated PD severity than with variables such as PD duration and cognitive function (rs < 0.5). PADLS scores differed across H&Y stages (Kruskal-Wallis test, p < 0.001). Those in H&Y stages IV-V had more ADL disability than those in stage III (Mann–Whitney U test, p < 0.001), whereas there were no significant differences between the other stages. Conclusion PADLS revealed excellent data completeness, acceptable targeting, and external construct validity. It seems to be well suited as a rough estimate of ADL disability in people with PD.

Initial Validation of a Self-Administered Version of the Freezing of Gait Questionnaire (FOGQsa)

Degeneration of the nigrostriatal dopaminergic system has traditionally been considered the pathological hallmark of Parkinson’s disease (PD). Recent neuropathological work, however, revealed that PD specific brain pathology extends far beyond the nigrostriatal dopaminergic system and affects widespread brain areas, including the olfactory system, autonomic and gain setting brainstem nuclei, and the cerebral cortex. In parallel, there has been a revival of interest in the non-motor features of PD. PD is now considered as a multisystem disorder, manifesting itself by a combination of the classical motor deficits and a wide range of non-motor disturbances, including autonomic dysregulation, hyposmia, sleep disturbances, depression, cognitive dysfunction, and psychosis. Evidence is accumulating that certain non-motor features of PD can develop at least several years before the onset of the motor symptoms. This has most convincingly been demonstrated for impaired olfaction and REM sleep behaviour disorder (RBD). Retrospective studies suggest that other symptoms, such as depression, autonomic dysfunction, and excessive daytime sleepiness may also antedate the motor symptoms. These so-called pre-motor symptoms most likely reflect early pathological changes in the olfactory bulb and tract, the lower brainstem, and possibly the peripheral autonomic nervous system, prior to the involvement of the substantia nigra. As such, pre-motor symptoms are an interesting target for the development of clinical screening tests to detect PD in the pre-motor phase. One of the most promising clinical pre-motor markers of PD is an impairment of the sense of smell, because of its high prevalence (8090% in the motor phase) and the non-invasiveness and low cost of olfactory testing. Prospective studies in first-degree relatives of PD patients and in a population-based cohort have established hyposmia as a risk factor for the development of PD, although the positive predictive value is low and the lead time appears to be relatively short. Idiopathic RBD has a higher positive predictive value than hyposmia and a longer lead time, but lacks sensitivity as only up to one third of PD patients suffer from this disorder. Although at this point no single pre-motor symptom is able to predict PD with high sensitivity and specificity, it is clear that clinical pre-motor markers of PD will be crucial to the development of neuroprotective treatment strategies.