Winser SJ1, Kannan P1, Bello UM1, Whitney SL2
1Hong Kong Polytechnic University (PolyU), Hung Hom, Hong Kong, 2University of Pittsburgh, Pittsburgh, United States

Background: A wide spectrum of outcome measures has been used to evaluate balance and predict falls in Parkinson's disease (PD). It is important to choose assessment tools with sound psychometric properties to ensure accuracy and reproducibility in assessing balance and predicting falls.

Purpose: We aimed at reviewing studies on psychometric analysis of measures of balance and falls risk tested among people with PD in order to 1) recommend psychometrically strong measures of balance and falls risk and categorize them according to the levels of assessment using the International Classification of Function (ICF) model and 2) provide implications for future research for further testing of psychometric property in people with PD.

Methods: We searched articles using the following electronic databases; PubMed, Embase, CINAHL, Ovid Medline, Scopus and Web of Science from date of inception of the database until May 2018. We categorized the identified outcome measures according to the level of assessment using the ICF model into one of the following levels: 1) body structure and function, 2) activity or 3) participation. The 4-point COSMIN was used to assess the methodological quality of studies included in this review.

Results: We screened 1543 studies to include 65 studies for this systematic review. This review identified 58 outcome measures assessing balance and 16 outcome measures assessing falls risk in people with PD. Sixteen outcome measures assessed balance at body, structure and function level, 36 assessed at activity level while six assessed at participatory level. Among the outcome measures on falls, two assessed at body, structure and function level, seven assessed at activity level and seven at participatory level. The Mini Balance Evaluation Systems Test (Mini-BESTest) assessing balance and falls risk at body, structure and function level, the Berg Balance Scale (BBS) and the Motor examination part of the Unified Parkinson's Disease Rating Scale (UPDRS-ME) assessing balance and the BBS assessing falls risk at activity level and the Activites-specific Balance Confidence (ABC) scale assessing balance and fall risk at participatory level are found to be psychometrically strong. Among the identified measures, one is disease-specific (UPRDS-ME) and the rest are generic measures of balance or falls risk.

Conclusion(s): The Mini-BESTest, BBS and ABC are psychometrically strong measures assessing balance and falls risk at the body, structure and function, activity and participatory levels respectively in people with PD. These three measures are easy to use, do not require sophisticated equipment's, quick to perform and are available free of cost. Responsiveness of the BBS is yet to be tested. We recommend the use of one of these measures along with the UPRDS-ME for efficient assessment of balance and falls risk.

Implications: Clinicians are recommended to carefully consider the level of assessment and depending on the level of assessment; a choice needs to be made between the three recommended measures. Performing a combination of generic (Mini-BESTest or BBs or ABC) and disease-specific measure (UPDRS-ME) is recommended for best results.

Keywords: Parkinson's disease, outcome measures, systematic review

Funding acknowledgements: Funding source: ´Start-up fund´ for early career, The Hong Kong Polytechnic University, Hong Kong (Grant ID: ZE6J)

Topic: Neurology: Parkinson's disease; Outcome measurement

Ethics approval required: No
Institution: The Hong Kong Polytechnic University
Ethics committee: NA
Reason not required: Systematic review

All authors, affiliations and abstracts have been published as submitted.

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