Development of a checklist for describing the performance of fall related activities by people with Parkinson's Disease

Jupp, K., Stack, E. and Ashburn, A. (2002) Development of a checklist for describing the performance of fall related activities by people with Parkinson's Disease. Physiotherapy, 88 (3), 171.

Abstract

Introduction: Falls are a major problem for elderly people in general but those with Parkinson’s Disease (PD) are at greater risk of instability. Knowledge is limited about the ways in which repeat fallers move about their environment. The aims of this study were to develop a tool for describing the movement strategies used when turning and reaching and to test for inter-observer reliability.
Method: People with PD (independently mobile and screened for cognitive dysfunction) were recruited through GPs. Video recordings of individuals turning and reaching high and low while making a cup of tea were made in participants’ homes. First, five skilled therapists independently identified movement strategies from the videos of seven people. Key strategies, agreed through consensus, formed the rating scale and comprised six items for turning (eg number of steps, turn type), five items for high reach (eg body alignment and support) and four items for low reach (eg instability and support). Inter-rater reliability was examined using two observers who independently rated the video recordings of performances.
Results: The video recordings of 66 subjects with PD were analysed. Their median age was 73 years (range 36 to 88) and they had moderate disease severity (median grade III,Hoehn and Yahr). Eleven out of the 14 items reached acceptable agreement, using Kappa coefficients (0.6 to 1.00), but turn type (0.56) and observed instability when turning were not shown to be reliable (0.48). The difference in the number of steps counted by observers was analysed using a Bland Altman approach and showed high agreement (mean difference –0.06, 95% range of difference –1.4 to1.2).
Conclusion: A checklist for analysing the components used when individuals turn and reach high and low when making a cup of tea was developed. Procedures for ensuring content validity and reliability were followed. The rating scale was designed for use in the home environment for assessment and evaluation of intervention.

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