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The circumstances of falls among people with Parkinson's disease and the use of Falls Diaries to facilitate reporting

The circumstances of falls among people with Parkinson's disease and the use of Falls Diaries to facilitate reporting
The circumstances of falls among people with Parkinson's disease and the use of Falls Diaries to facilitate reporting
Purpose: falls are common in Parkinson's disease (PD). Falls Diaries are one way of recording fall frequency and the surrounding circumstances; completing them encourages recall, and their content focuses intervention. We reviewed the diaries completed by people with PD during a randomized controlled trial (RCT) of fall prevention to ascertain the key circumstances surrounding falls.

Method: we asked independently mobile, cognitively intact people with a diagnosis of PD to maintain a Falls Diary throughout a six-month RCT. We sent monthly diary sheets on which to answer questions about the 'Location', 'Fall-related activity', 'Perceived cause', 'Landing' and 'Consequences' of every fall. We coded responses and counted frequencies.

Results: of the 142 RCT participants (mean age 72 years; mean years since diagnosis 8), 135 completed the trial and their diary. We excluded 11 (8%) for missing data and/or unintelligible writing. The 124 remaining diaries recorded 639 falls: 80% happened at home, commonly in bedrooms, living areas, kitchens and gardens. Fallers had been ambulant in 45% of events, standing in 32% and transferring in 21%. Six 'activity-cause combinations' accounted for 55% of falls (tripping 13%; freezing, festination and retropulsion 11%; and postural instability when bending or reaching 9%, transferring 8%, walking 7% and washing or dressing 7%). Misjudgement and distraction played a part in 12% of falls described.

Conclusions: of over 600 falls surveyed, most happened at home, provoked by postural instability, tripping and freezing. Environmental adaptation and cognitive training should be trialled in falls prevention in PD, plus or minus traditional movement rehabilitation. Most participants completed Falls Diaries successfully. We advocate diary use, with follow-up interviews, in research and clinically. People with handwriting difficulty may require a typed diary, proxy diarist or interview
parkinson's disease, falls diaries, fall circumstances
0963-8288
1205-1212
Ashburn, A.
818b9ce8-f025-429e-9532-43ee4fd5f991
Stack, E.
7adccc27-4910-41bb-adc4-409e00a89601
Ballinger, C.
1495742c-90aa-4074-920e-95e6cc3d5380
Fazakarley, L.
63b3281c-9d7d-4138-ba39-9a722a86f7df
Fitton, C.
6288734e-9b6e-470d-b420-33c16d65b879
Ashburn, A.
818b9ce8-f025-429e-9532-43ee4fd5f991
Stack, E.
7adccc27-4910-41bb-adc4-409e00a89601
Ballinger, C.
1495742c-90aa-4074-920e-95e6cc3d5380
Fazakarley, L.
63b3281c-9d7d-4138-ba39-9a722a86f7df
Fitton, C.
6288734e-9b6e-470d-b420-33c16d65b879

Ashburn, A., Stack, E., Ballinger, C., Fazakarley, L. and Fitton, C. (2008) The circumstances of falls among people with Parkinson's disease and the use of Falls Diaries to facilitate reporting. Disability and Rehabilitation, 30 (16), 1205-1212. (PMID:18608387)

Record type: Article

Abstract

Purpose: falls are common in Parkinson's disease (PD). Falls Diaries are one way of recording fall frequency and the surrounding circumstances; completing them encourages recall, and their content focuses intervention. We reviewed the diaries completed by people with PD during a randomized controlled trial (RCT) of fall prevention to ascertain the key circumstances surrounding falls.

Method: we asked independently mobile, cognitively intact people with a diagnosis of PD to maintain a Falls Diary throughout a six-month RCT. We sent monthly diary sheets on which to answer questions about the 'Location', 'Fall-related activity', 'Perceived cause', 'Landing' and 'Consequences' of every fall. We coded responses and counted frequencies.

Results: of the 142 RCT participants (mean age 72 years; mean years since diagnosis 8), 135 completed the trial and their diary. We excluded 11 (8%) for missing data and/or unintelligible writing. The 124 remaining diaries recorded 639 falls: 80% happened at home, commonly in bedrooms, living areas, kitchens and gardens. Fallers had been ambulant in 45% of events, standing in 32% and transferring in 21%. Six 'activity-cause combinations' accounted for 55% of falls (tripping 13%; freezing, festination and retropulsion 11%; and postural instability when bending or reaching 9%, transferring 8%, walking 7% and washing or dressing 7%). Misjudgement and distraction played a part in 12% of falls described.

Conclusions: of over 600 falls surveyed, most happened at home, provoked by postural instability, tripping and freezing. Environmental adaptation and cognitive training should be trialled in falls prevention in PD, plus or minus traditional movement rehabilitation. Most participants completed Falls Diaries successfully. We advocate diary use, with follow-up interviews, in research and clinically. People with handwriting difficulty may require a typed diary, proxy diarist or interview

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More information

Published date: 2008
Keywords: parkinson's disease, falls diaries, fall circumstances
Organisations: Primary Care & Population Sciences, Health Profs and Rehabilitation Sciences

Identifiers

Local EPrints ID: 17907
URI: https://eprints.soton.ac.uk/id/eprint/17907
ISSN: 0963-8288
PURE UUID: 8da29d7c-8b9d-4e31-a2ce-1ae606dac445

Catalogue record

Date deposited: 19 May 2009
Last modified: 09 Nov 2017 12:51

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Contributors

Author: A. Ashburn
Author: E. Stack
Author: C. Ballinger
Author: L. Fazakarley
Author: C. Fitton

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