Posturography and Risk of Recurrent Falls in Healthy Non-Institutionalized Persons Aged Over 65 Clinical and posturographic correlates of falling in Parkinson's disease. A comparison of four functional tests in discriminating fallers from non-fallers in older people Instrumented Test of Sensory Integration for Balance: A Validation Study The comparative ability of eight functional mobility tests for predicting falls in community-dwelling older people. Validity of the Dynamic Gait Index in People With Multiple Sclerosis Utility of Disease-Specific Measures and Clinical Balance Tests in Prediction of Falls in Persons With Multiple Sclerosis A pilot study to explore the predictive validity of 4 measures of falls risk in frail elderly patients. Comparison of Self-report and Performance-Based Balance Measures for Predicting Recurrent Falls in People With Parkinson Disease: Cohort Study Predicting falls among patients with multiple sclerosis: Comparison of patient-reported outcomes and performance-based measures of lower extremity functions. Objective Assessment of Fall Risk in Parkinson's Disease Using a Body-Fixed Sensor Worn for 3 Days Hip muscle and hand-grip strength to differentiate between older fallers and non-fallers: a cross-sectional validity study Identification of high risk fallers among older people living in residential care facilities: a simple screen based on easily collectable measures. Predicting accidental falls in people with multiple sclerosis — a longitudinal study Risk factors for falls in multiple sclerosis: an observational study External validation of a simple clinical tool used to predict falls in people with Parkinson disease. A prospective evaluation of balance, gait, and strength to predict falling in women with multiple sclerosis. Mobility, Balance and Falls in Persons with Multiple Sclerosis
Background : A poor postural stability in older people is associated with an increased risk of falling . The posturographic tool has widely been used to assess balance control ; however , its value in predicting falls remains unclear . Objective : The purpose of this prospect i ve study was to determine the predictive value of posturography in the estimation of the risk of recurrent falls , including a comparison with st and ard clinical balance tests , in healthy non-institutionalized persons aged over 65 . Methods : Two hundred and six healthy non-institutionalized volunteers aged over 65 were tested .  Postural control  was evaluated by posturographic tests , performed on static , dynamic and dynamized platforms ( static test , slow dynamic test and Sensory Organization Test [ SOT ] ) and clinical balance tests ( Timed ‘ Up & Go ’ test , One-Leg Balance , Sit-to-St and -test ) .  Subsequent falls were monitored prospect ively with self- question naire sent every 4 months for a period of 16 months after the balance testing . Subjects were classified prospect ively in three groups of Non-Fallers ( 0 fall ) , Single-Fallers ( 1 fall ) and Multi-Fallers ( more than 2 falls ) . Results : Loss of balance during the last trial of the SOT sensory conflicting condition , when visual and somatosensory inputs were distorted , was the best factor to predict the risk of recurrent falls ( OR = 3.6 , 95 % CI = 1.3–10.11 ) . Multi-Fallers showed no postural adaptation during the repetitive trials of this sensory condition , contrary to Non-Fallers and Single-Fallers . The Multi-Fallers showed significantly more sway when visual inputs were occluded . The clinical balance tests , the static test and the slow dynamic test revealed no significant differences between the groups . Conclusion : In a sample of non-institutionalized older persons aged over 65 , posturographic evaluation by the SOT , especially with repetition of the same task in sensory conflicting condition , compared to the clinical tests and the static and dynamic posturographic test , appears to be a more sensitive tool to identify those at high-risk of recurrent falls Various clinical tests and balance scales have been used to assess postural stability and the risk of falling in patients with idiopathic Parkinson 's disease ( IPD ) .  Quantitative posturography allows a more objective assessment but the findings in previous studies have been inconsistent and few studies have investigated which posturographic measures correlate best with a history of falling . The purpose of this study was to determine the efficacy of clinical tests , balance scales , and  stable-platform posturography  in detecting postural instability and discriminating between fallers and non-fallers in a home-dwelling PD cohort . Forty-eight PD subjects ( Hoehn & Yahr stage 1 - 3 ) and 17 age-matched controls had the following assessment s : Activities-specific Balance Confidence scale , Berg Balance Scale , Unified Parkinson 's Disease Rating Scale ( UPDRS ) ( motor ) , pull-test , timed up- and -go , static posturography , and dynamic posturography to assess multidirectional leaning balance . Of the clinical assessment s , all but the pull-test were closely correlated with a history of falling .  Static posturography  discriminated between PD fallers and controls but not between PD fallers and non-fallers , whereas  dynamic posturography ( reaction time , velocity , and target hit-time ) also discriminated between fallers and non-fallers . Our findings suggest that this combination of clinical and posturographic measures would be useful in the prospect i ve assessment of falls risk in PD patients . A further prospect i ve study is now required to assess their predictive value . © 2013 Movement Disorder Society Purpose : Which functional tests on mobility and balance can better screen older people at risk of falls is unclear . This study aims to compare the  Berg Balance Scale ( BBS ) , Tinetti Mobility Score ( TMS ) , Elderly Mobility Scale ( EMS ) and Timed Up and Go test ( TUG )  in discriminating fallers from non-fallers in older people . Method : This was a case-control study involving one rater who conducted a mobility and balance assessment on subjects using the four functional tests in r and om sequence .  Subjects recruited included 17 and 22 older people with a history of single and multiple falls respectively from a public Falls Clinic , and 39 community-dwellers without fall history and whose age , sex and BMI matched those of the fallers . All subjects underwent the mobility and balance assessment within one day . Results : Single fallers performed better than multiple fallers in all four functional tests but were worse than non-fallers in the BBS , TMS and TUG . The BBS demonstrated the best discriminating ability , with high sensitivity and specificity . The BBS item ` pick up an object from the floor ' was the best at screening fallers . Conclusion : BBS was the most powerful functional test of the four in discriminating fallers from non-faller Background and Purpose : Abnormal postural sway is associated with an increase in risk of falls but is difficult for clinicians to accurately quantify without access to laboratory equipment . Instrumenting clinical outcome measures using body-worn movement monitors is a low-cost alternative . This is the first study to compare the modified Clinical Test of Sensory Integration for Balance ( i-mCTSIB ) to the laboratory test of the Sensory Organization Test ( SOT ) with dynamic posturography in a group of participants with Parkinson 's disease ( PD ) and subtle balance limitations . The purpose of this study was to ( 1 ) determine the concurrent validity of the i-mCTSIB with the SOT ( 6 and 4 conditions ) and ( 2 ) compare the i-mCTSIB and the SOT to differentiate between individuals with and without recent falls within the previous 6 months . Methods : This cross-sectional study examined 26 participants with idiopathic PD who had a Motor Unified Parkinson 's Disease Rating Scale score of 32.7 ( 13.5 ) out of 108 . Results : The composite and conditions 1 and 4 of the i-mCTSIB and SOT scores were significantly correlated : composite scores r = −0.64 ( P ⩽ .001 ) , C1 r = −0.43 ( P = .03 ) , C3 r = −0.60 ( P ⩽ .01 ) , and C4 r = −0.54 ( P ⩽ .001 ) . A significant difference was observed in mean i-mCTSIB composite scores between fallers and nonfallers ( P = .04 ) . In contrast , the SOT composite was not significantly different between fallers and nonfallers ( P = 0.31 ) . Discussion : The results suggest that the i-mCTSIB may be a valid and clinical ly meaningful measure of sensory organization in persons with PD , even those with mild postural instability as measured by the median Hoehn and Yahr score ( 2.0 ) . Future research should evaluate predictive validity of the i-mCTSIB for prospect i ve falls . Conclusion : The instrumented mCTSIB with portable , body-worn movement allows clinicians to quantify abnormal postural sway without the ceiling effects of clinical balance testing or the expense and importability of force plate technology in the SOT . Instrumenting mCTSIB may also distinguish between fallers and nonfallers BACKGROUND numerous tests have been suggested as fall risk indicators . However , the validity of these assessment s has not been demonstrated in large representative sample s of community-dwelling older people . OBJECTIVE the objective of this study was to examine the comparative ability and clinical utility of eight mobility tests for predicting multiple falls in older community-dwelling people . METHODS design -- prospect i ve cohort study ; subjects--362 subjects aged 74 - 98 years ; measurements --the sit-to-st and test with one and five repetitions , the pick-up-weight test , the half-turn test , the alternate-step test ( AST ) , the six-metre-walk test ( SMWT )  and  stair ascent and descent tasks . Falls were monitored for 1 year with fall calendars . RESULTS in the 12-month follow-up period , 80 subjects ( 22.1 % ) suffered two or more falls . Multiple fallers performed significantly worse than non-multiple fallers in the sit-to-st and test with five repetitions ( STS-5 ) , the AST , the  half-turn test  , the  SMWT  and the stair-descent test .  When dichotomised using cut-off points from receiver-operated characteristics ( ROC ) curve analyses , these tests demonstrated reasonable sensitivity and specificity in identifying multiple fallers . A principal components analysis identified only one factor underlying the mobility tests . Poor performances in two mobility tests , however , increased the risk of multiple falls more than poor performance in one test alone ( ORs = 3.66 , 95 % CI = 1.44 , 9.27 and 1.61 , 95 % CI = 0.62 , 4.16 respectively ) . CONCLUSIONS the mobility tests appear to be measuring a similar ' mobility ' construct . Based on feasibility and predictive validity , the AST , STS-5 and SMWTs were the best tests Background Evaluation of walking capacity and risk of falls in people with multiple sclerosis often are performed in rehabilitation . The Dynamic Gait Index ( DGI ) evaluates walking during different tasks , but the feasibility in identifying people at risk for falls needs to be further investigated . Objective The objective of this study was to investigate ( 1 ) the construct validity ( known groups , convergent , and discriminant ) of the DGI and ( 2 ) the accuracy of predicting falls and establishing a cutoff point to identify fallers . Design This trial was a multicenter , cross-sectional study . Methods A convenience sample was composed of 81 people with multiple sclerosis with subjective gait and balance impairment who were able to walk 100 m ( comparable to Exp and ed Disability Status Scale 1–6 ) . Mean age of the participants was 49 years ; 76 % were women . The  25-Foot Timed Walk Test , Timed “ Up & Go ” Test , Four Square Step Test , Timed Sit-to-St and Test , MS Walking Scale , Multiple Sclerosis Impact Scale , and self-reported falls during the previous  2 months were used for validation , to establish cutoff points for identifying fallers , and to investigate predictive values . Results Significantly lower DGI scores ( P≤.001 ) were found for participants reporting falls ( n=31 ) . High sensitivity ( 87 % ) in identifying fallers was found , with a cutoff score ≤19 . The positive predictive value was 50 % , and the negative predictive value was 87 % . The positive likelihood ratio was 1.77 , and the negative likelihood ratio was 0.26 . The convergent validity was moderate to strong ( ρ=0.58–0.80 ) , with the highest correlation coefficient found for the 25-Foot Timed Walk Test . Discriminant validity was shown with low correlation for the psychological subscale of the Multiple Sclerosis Impact Scale . Limitations The sample included ambulatory people participating in a r and omized controlled trial investigating balance training . Conclusions The DGI is a valid measure of dynamic balance during walking for ambulatory people with multiple sclerosis . With the cutoff point of ≤19 , sensitivity was high in identifying people at risk of falls Background and Purpose : The sensory and motor deficits associated with multiple sclerosis ( MS ) contribute to falls with the majority of persons with MS falling at least once annually . To appropriately direct treatment , accurate fall prediction measures are needed . In this study of community-dwelling individuals with MS followed for 12 months , we sought to determine frequency of falls , utility of clinical balance tests to predict falls , and accuracy of participants ' retrospective recall of fall events . Methods : Independently ambulatory persons with MS underwent 5 clinical balance tests including Activities-specific Balance Confidence , Berg Balance Scale , Functional Reach , Timed Up and Go , and Dynamic Gait Index , and one disease-specific measure of disability  ( Exp and ed Disability Status Scale ) and then were followed for 1 year . Participants were queried monthly by phone to determine the number of fall events that had occurred . Accuracy of fall prediction was determined by receiver operating characteristic curve analysis and comparison of balance test performance between fallers and nonfallers . Results : Sixty-one percent of the 38 participants were classified as fallers at 12-month follow-up . Only the Berg Balance Scale , Dynamic Gait Index , and the Activities-specific Balance Confidence demonstrated clinical ly useful levels of accuracy . In addition , participants were generally poor in their accurate recall of fall events relative to their monthly fall reports . Discussion and Conclusions : The majority of participants fell during a 1-year prospect i ve follow-up . Only 2 balance performance measures and 1 balance confidence measure accurately distinguished between fallers and nonfallers as well as possessed clinical ly useful levels of sensitivity and specificity . These results also emphasized the inaccuracy of retrospective fall history in an MS sample . Video Abstract available ( see Supplemental Digital Content 1 , http://links.lww.com/JNPT/A55 ) for more insights from the author OBJECTIVES To test the hypothesis that scores on 4 falls risk measures  will differ significantly in patients reporting recurrent falls compared with those who do not ; and to explore the validity of each measure to predict such falls status . DESIGN A convenience sample was tested to establish the sensitivity and specificity of the  Functional Reach Test , Timed Up & Go test , one-leg stance test ( OLST )  , and  balance subsection of the Performance Oriented Mobility Assessment ( B-POMA ) . A 12-month retrospective falls history was used to identify recurrent fallers . SETTING A day hospital for the elderly . PARTICIPANTS Convenience sample of 30 day hospital patients . The inclusion criteria were : ability to rise from a chair and walk 6 m ; no severe cognitive impairment or blindness ; age 65 years or older . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Scores on the 4 tests and retrospective falls histories . RESULTS Scores on the B-POMA and OLST showed significant differences between fallers and nonfallers ( P<.05 ) . An  OLST time of 1.02 seconds or less ( odds ratio [OR]=15.2 ; 95 % confidence interval [ CI ] , 1.72 - 133.95 ) and B-POMA score of 11 or less ( OR=18.5 ; 95 % CI , 2.05 - 167.79 ) were predictive of day hospital patients having a history of recurrent falls . CONCLUSIONS OLST and B-POMA both have potential as screening tools for risk of falls , but this observation requires confirmation in a prospect i ve study Background Balance confidence and fear of falling are factors associated with recurrent falls in people with Parkinson disease ( PD ) . However , the accuracy for predicting falls on the basis of self-report measures has not been widely investigated . Objective The study objectives were : ( 1 ) to compare the accuracy of the  Activities-specific Balance Confidence Scale ( ABC )  and the  Falls Efficacy Scale – International ( FES-I )  with that of the  Berg Balance Scale  ( BBS ) , Dynamic Gait Index  ( DGI ) , Functional Reach Test ( FRT ) , and Timed “ Up & Go ” Test ( TUG ) for predicting recurrent falls in people with PD and ( 2 ) to explore the ability of combinations of up to 3 tests to predict recurrent falls . Design This was a prospect i ve cohort study involving 225 people with PD . Methods Participants were assessed with the  ABC , FES-I , BBS , FRT , TUG , and DGI . Participants who reported 2 or more falls in the 12-month follow-up period were classified as recurrent fallers . Areas under the receiver operating characteristic curves were determined , and the Akaike information criterion was used to select the best predictive model . Results Eighty-four participants ( 37.3 % ) were classified as recurrent fallers . Areas under the receiver operating characteristic curves for the ABC , FES-I , TUG , FRT , DGI , and BBS were 0.73 , 0.74 , 0.72 , 0.74 , 0.76 , and 0.79 , respectively . Two-test models provided additional discriminating ability compared with individual measures and had Akaike information criterion values similar to those of 3-test models , particularly the combination of the BBS with the FES-I. Limitations The lack of an external validation sample was a limitation of this study . Conclusions The ABC and FES-I demonstrated moderate accuracy in predicting recurrent falls and a predictive ability similar to that of performance-based balance measures , especially the FRT and the TUG . Two-test models showed performance similar to that of 3-test models , suggesting that a combination of 2 measures may improve the ability to predict recurrent falls in people with PD . Specifically , the combination of the BBS with the FES-I may be considered BACKGROUND Accurate fall screening tools are needed to identify those multiple sclerosis ( MS ) patients at high risk of falling . The present study aim ed at determining the validity of a series of performance-based measures ( PBMs ) of lower extremity functions and patient-reported outcomes ( PROs ) in predicting falls in a sample of MS patients ( n = 84 ) , who were ambulatory independent . METHODS Patients were assessed using the following PBMs : timed up and go ( TUG ) , timed 25-foot walk ( T25FW ) , cognitive T25FW , 2-min walk ( 2MW ) , and cognitive 2MW . Moreover , a series of valid and reliable PROs were filled in by participants including the activities-specific balance confidence ( ABC ) , 12-item multiple sclerosis walking scale ( MSWS-12 ) , fall efficacy scale international ( FES-I ) , and modified fatigue impact scale ( MFIS ) . The dual task cost ( DTC ) of 2MW and T25FW tests were calculated as a percentage of change in parameters from single to dual task conditions . Participants were classified as none-fallers and fallers ( ⩾1 ) based on their prospect i ve fall occurrence . RESULTS In the present study , 41(49 % ) participants recorded ≥ 1 fall and were classified as fallers . The results of logistic regression analysis revealed that each individual test , except DTC of 2MW and T25FW , significantly predicted future falls . However , considering the area under the curves ( AUCs ) , PROs were more accurate compared to PBMs . In addition , the results of multiple logistic regression with the first two factors extracted from principal component analysis revealed that both factor 1 ( PROs ) and factor 2 ( PBMs ) significantly predicted falls with a greater odds ratio ( OR ) for factor 1 ( factor 1 : P = < 0.0001 , OR = 63.41 ( 6.72 - 597.90 ) ) than factor 2 ( P < 0.05 , OR = 5.03 ( 1.33 - 18.99 ) ) . CONCLUSIONS The results of this study can be used by clinicians to identify and monitor potential fallers in MS patients Background Patients with Parkinson 's disease ( PD ) suffer from a high fall risk . Previous approaches for evaluating fall risk are based on self-report or testing at a given time point and may , therefore , be insufficient to optimally capture fall risk . We tested , for the first time , whether metrics derived from 3 day continuous recordings are associated with fall risk in PD . Methods and Material s 107 patients ( Hoehn & Yahr Stage : 2.6±0.7 ) wore a small , body-fixed sensor ( 3D accelerometer ) on lower back for 3 days .  Walking quantity ( e.g. , steps per 3-days ) and quality ( e.g. , frequency-derived measures of gait variability ) were determined . Subjects were classified as fallers or non-fallers based on fall history . Subjects were also followed for one year to evaluate predictors of the transition from non-faller to faller . Results The 3 day acceleration derived measures were significantly different in fallers and non-fallers and were significantly correlated with previously vali date d measures of fall risk . Walking quantity was similar in the two groups . In contrast , the fallers walked with higher step-to-step variability , e.g. , anterior-posterior width of the dominant frequency was larger ( p = 0.012 ) in the fallers ( 0.78±0.17 Hz ) compared to the non-fallers ( 0.71±0.07 Hz ) . Among subjects who reported no falls in the year prior to testing , sensor-derived measures predicted the time to first fall ( p = 0.0034 ) , whereas many traditional measures did not . Cox regression analysis showed that anterior-posterior width was significantly ( p = 0.0039 ) associated with time to fall during the follow-up period , even after adjusting for traditional measures . Conclusions / Significance These findings indicate that a body-fixed sensor worn continuously can evaluate fall risk in PD . This sensor-based approach was able to identify transition from non-faller to faller , whereas many traditional metrics were not successful . This approach may facilitate earlier detection of fall risk and may in the future , help reduce high costs associated with falls Background Hip muscle weakness in older people seems to be an influencing factor of falls . Currently , it is unclear which muscles out of the hip muscle group play an important role in older people . A validating process in the measurement regarding muscle strength related to falls is necessary before answering that question . Objective Firstly , we aim ed to investigate which hip muscle group strength shows an acceptable level of distinction between older adult fallers and non-fallers compared to a predefined external criterion regarding falling . Secondly , we aim ed to compare the same outcomes and questions for h and -grip strength in relation to the same external criterion . Design This study was a cross-sectional validity study . Methods The  maximum voluntary isometric strength ( MVIS ) and the rate of force generation of hip abductors ( ABD ) , adductors , internal and external rotators , extensors , and flexors were measured with a dynamometer fixed to a custom-made frame as well as h and -grip strength with a Martin Vigorimeter in 60 older people aged over 65 years ( 38 females and 22 males ) . Results The area under the curve ( AUC ) and the results of the mean decrease in Gini index assessed by r and om forest approach show that of all the assessed parameters , hip ABD MVIS showed the highest discriminative value regarding the chosen external criterion in older people ( AUC ABD MVIS 0.825 , 95 % confidence interval : 0.712–0.938 ) . Conclusion Results indicate that ABD MVIS is a useful measure to distinguish between older adult fallers and non-fallers regarding the chosen external criterion PURPOSE To develop a simple screen based on easily collectable measures to identify older people living in residential care facilities at high risk of falls . METHODS This prospect i ve study was conducted in seven residential care facilities in the U.K. Residents aged>60 years who were not bedbound or terminally ill participated .  Demographics , medical history , medication use , cognition ( mini mental state examination ( MMSE ) ) , function ( Barthel , balance and sit-to-st and ability ) and behavior ( neuro-psychiatric inventory ( NPI ) and impulsivity ) were recorded at baseline . Falls and injuries were prospect ively recorded over 6 months . Data were analyzed for differences between fallers and non-fallers and significant variables entered into logistic regression analysis . RESULTS Two hundred and forty residents completed the study . In the follow-up period , 50 % fell ≥1 times . Fallers had worse function , cognition , behavior and balance and took more medications . Falling in the past year , walking frame and hypnotic/anxiolytic and anti-depressant medication use were also associated with increased likelihood of falling . Logistic regression identified MMSE<17 , impulsivity score ≥ 2 , st and ing balance score<6 , requiring a walking frame , falling in the previous year and use of antidepressants and hypnotics/anxiolytics as independent and significant predictors of falls . The area under the receiver operating curve ( ROC ) for this model was 0.79 ( 95 % CI 0.73 - 0.84 ) . CONCLUSIONS This tool comprising multi-factorial measures provides a simple way of quantifying the probability with which a care home resident will fall over a 6-month period . The tool may also assist in guiding the development and targeting of interventions to prevent falls in this group Objective : To investigate accidental falls and near fall incidents in people with multiple sclerosis with respect to clinical variables and the predictive values of four tests . Design : A longitudinal , multi-centred cohort study with prospect ively collected falls . Procedures : Self-reported incidents during the three months following a st and ardized test procedure . Subjects : Seventy-six people with multiple sclerosis and an Exp and ed Disability Status Scale score between 3.5 and 6.0 . Main outcome measures : Berg Balance Scale , Timed Up and Go cognitive , Four Square Step Test ( FSST ) and 12-item Multiple Sclerosis Walking Scale . Results : Forty-eight people ( 63 % ) registered 270 falls . Most falls occurred indoors during activities of daily life . We found a correlation of rs=0.57 between near falls and falls , and of rs = 0.82 between registered and retrospectively recalled falls . Fallers and non-fallers differed significantly regarding Exp and ed Disability Status Score ( odds ratio ( OR ) 1.99 , 95 % confidence interval ( CI ) 1.22 ; 3.40 ) , spasticity ( OR 1.14 , CI 1.02 ; 1.31 ) , proprioception ( OR 2.50 , CI 1.36 ; 5.12 ) and use of walking aids ( OR 2.27 , CI 1.23 ; 4.37 ) . Reported use of walking aids both indoors and outdoors increased the odds of falling fivefold while disturbed proprioception increased the odds 2.5—15.6 times depending on severity . The odds of falling were doubled for each degree of increased Exp and ed Disability Status Score and more than doubled for each degree of increased spasticity . The Berg Balance Scale , use of walking aids and Timed Up and Go cognitive best identified fallers ( 73—94 % ) and proprioception , Exp and ed Disability Status Score , 12-item Multiple Sclerosis Walking Scale and Four Square Step Test best identified non-fallers ( 75—93 % ) . Conclusions : In clinical practice , looking at the use of walking aids , investigating proprioception and spasticity , rating Exp and ed Disability Status Score and using Berg Balance Scale or Timed Up and Go cognitive all contribute when identifying fallers Background : People with multiple sclerosis ( MS ) experience frequent falls , which are associated with impairments and limitations to activities and participations . Objective : The objective of this paper is to evaluate falls risk factors using robust clinical measures . Methods : A total of 150 individuals ( confirmed MS diagnosis , Exp and ed Disability Status Scale ( EDSS ) 3.5–6.5 ) were recruited , with 148 participants included in the final analysis . Demographic data were collected and performance assessed in eight predictor measures  ( Physiological Profile Assessment ( PPA ) , Brief Ataxia Rating scale , Ashworth scale ( Ashworth ) , Modified Falls Efficacy scale , Symbol Digit Modalities Test , dual-task interference , lying/st and ing blood pressure , static/dynamic visual acuity )  . Participants prospect ively recorded falls over three months using a daily diary . People were classified as “ fallers ” based on reports of ≥ two falls . Results : A total of 104 participants recorded 672 falls ; 78 ( 52.7 % ) reported ≥ two falls . Continence issues , previous falls history and use of prescribed medications were each associated with increased risk of being a “ faller ” . Ashworth and PPA risk score contributed significantly to a logistic regression model predicting faller/non-faller classification . The reduced model ( Ashworth , PPA , EDSS ) showed fair-to-good predictive ability ( ROC c-statistic 0.73 , sensitivity 70 % , specificity 69 % ) . Conclusion : This study confirms the high prevalence of falls in ambulant people with MS . Important potentially modifiable risk factors are identified , suggesting aspects to target in falls interventions BACKGROUND Assessment of fall risk in an individual with Parkinson disease ( PD ) is a critical yet often time consuming component of patient care . Recently a simple clinical prediction tool based only on fall history in the previous year , freezing of gait in the past month , and gait velocity < 1.1 m/s was developed and accurately predicted future falls in a sample of individuals with PD . METHODS We sought to externally vali date the utility of the tool by administering it to a different cohort of 171 individuals with PD .  Falls were monitored prospect ively for 6 months following predictor assessment . RESULTS The tool accurately discriminated future fallers from non-fallers ( area under the curve [ AUC ] = 0.83 ; 95 % CI 0.76 - 0.89 ) , comparable to the developmental study . CONCLUSION The results vali date d the utility of the tool for allowing clinicians to quickly and accurately identify an individual 's risk of an impending fall OBJECTIVE To identify measures of balance , gait , and strength that predict falls in women with multiple sclerosis ( MS ) . DESIGN This prospect i ve study followed participants for 1 year . SETTING University research laboratories . PARTICIPANTS A convenience sample of women with MS ( N=99 ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Balance was assessed with the  limits of stability ( LOS ) test  and the  Sensory Organization Test .  Peak force , torque , and power of knee flexors and extensors as well as hip abductors and adductors were also measured . Temporal-spatial parameters of gait  were measured by an instrumented walkway system . For 1 year after baseline assessment s , the participants reported their falls . Participants were then classified based on the number of reported falls for use in logistic regression models to predict either people with at least 1 fall or people with at least 2 falls ( recurrent fallers ) . RESULTS A total of 159 falls were reported by 48 % of the participants .  Exp and ed Disability Status Scale scores , leaning forward to the LOS , and st and ing sway within a visually referenced surround significantly predicted people with at least 1 fall as well as recurrent fallers . Stance-phase asymmetries and base-of-support width during gait , as well as the force and power produced during leg extension or flexion additionally predicted recurrent fallers . The models ' overall predictive accuracy ranged from 69 % to 85 % . CONCLUSIONS This prospect i ve study confirmed the prevalence and multifactorial nature of falls in this MS sample . In addition to advancing disease status , impaired forward LOS and visually dependent sway ( as well as gait asymmetries and leg flexor-extensor weakness for recurrent fallers ) predict future falls in women with MS Background There is a lack of information concerning the relation between objective measures of gait and balance and fall history in persons with MS ( PwMS ) . This investigation assessed the relation between demographic , clinical , mobility and balance metrics and falls history in persons with multiple sclerosis ( MS ) . Methods 52 ambulatory persons with MS ( PwMS ) participated in the investigation . All persons provided demographic information including fall history over the last 12 months . Disease status was assessed with Exp and  ed Disability Status Scale ( EDSS ) . Walking speed , coordination , endurance and postural control were quantified with a multidimensional mobility battery . Results Over 51 % of the participants fell in the previous year with 79 % of these people being suffering recurrent falls . Overall , fallers were older , had a greater prevalence of assistive devices use , worse disability , decreased walking endurance , and greater postural sway velocity with eyes closed compared to non-fallers . Additionally , fallers had greater impairment in cerebellar , sensory , pyramidal , and bladder/bowel subscales of the EDSS . Conclusions The current observations suggest that PwMS who are older , more disabled , utilize an assistive device , have decreased walking coordination and endurance and have diminished balance have fallen in the previous year . This suggests that individuals who meet these criteria need to be carefully monitored for future falls . Future research is needed to determine a prospect i ve model of falls specific to PwMS . Additionally , the utility of interventions aim ed at reducing falls and fall risk in PwMS needs to be established
Meta- analysis demonstrated fallers perform significantly worse than non-fallers on all measures analysed except the Timed Up and Go Cognitive ( p < 0.05 ) , but discriminative ability of the measures is commonly not reported .
Of those reported , the Activities-specific Balance Confidence Scale had the highest area under the receiver operating characteristic curve value ( 0.92 ) , but without reporting corresponding measures of clinical utility .
Conclusion : Clinical measures of balance differ significantly between fallers and non-fallers but have poor predictive ability for falls risk in people with multiple sclerosis
Objective : To determine the ability of clinical measures of balance to distinguish fallers from non-fallers and to determine their predictive validity in identifying those at risk of falls .