Article

Falls are a common and disabling feature of Parkinson disease (PD).
Early identification of patients at greatest risk of falling is a key goal of
physical therapy assessment. The Timed "Up & Go" Test (TUG), a frequently used
mobility assessment tool, has moderate sensitivity and specificity for
identifying fall risk. OBJECTIVE: The study objective was to investigate whether
adding a task (cognitive or manual) to the TUG (TUG-cognitive or TUG-manual,
respectively) increases the utility of the test for identifying fall risk in
people with PD. DESIGN: This was a retrospective cohort study of people with PD
(N=36). METHODS: Participants were compared on the basis of self-reported fall
exposure in the preceding 6 months (those who had experienced falls ["fallers"]
versus those who had not ["nonfallers"]). The time taken to complete the TUG,
TUG-cognitive, and TUG-manual was measured for both groups. Between-group
differences were calculated with the Mann-Whitney U test. The discriminative
performance of the test at various cutoff values was examined, and estimates of
sensitivity and specificity were based on receiver operating characteristic curve
plots. RESULTS: Fallers took significantly longer than nonfallers (n=19) to
complete the TUG under all 3 conditions. The TUG-cognitive showed optimal
discriminative performance (receiver operating characteristic area under the
curve=0.82; 95% confidence interval [CI]=0.64, 0.92) at a cutoff of 14.7 seconds.
The TUG-cognitive was more likely to correctly classify participants with a low
risk of falling (positive likelihood ratio=2.9) (<14.7 seconds) and had higher
estimates of sensitivity (0.76; 95% CI=0.52, 0.90) than of specificity (0.73; 95%
CI=0.51, 0.88) at this threshold (negative likelihood ratio=0.32). LIMITATIONS:
Retrospective classification of fallers and nonfallers was used. CONCLUSIONS: The
addition of a cognitive task to the TUG enhanced the identification of fall risk
in people with PD. The TUG-cognitive should be considered a component of a
multifaceted fall risk assessment in people with PD.
CI - (c) 2015 American Physical Therapy Association.

Langue : ANGLAIS