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B. Jutzi1,2, G. Luder2, I. Lehmann2, L. Lachenmayer3, J. Michelis3, I. Debove3, J. Muellner3
1University of Applied Science, Health, Bern, Switzerland, 2Inselspital, Bern University Hospital, Department of Physiotherapy, Bern, Switzerland, 3Inselspital, Bern University Hospital, Department for Movement Disorders, Bern, Switzerland
Background: Falls are common for people with Parkinson’s disease and have severe negative consequences and impacts on quality of life. Postural impairments often do not respond to levodopa and may further deteriorate with deep brain stimulation (DBS). Some studies suggest a higher risk of falling after DBS.
Purpose: This study investigated as its primary aim the risk of falling and as its secondary aim the fear of falling for people with Parkinson’s disease before and after deep brain stimulation of the subthalamic nucleus (STN-DBS).
Methods: People with Parkinson’s disease treated at the university hospital of Berne and qualifying for STN-DBS surgery were included in this study. Their risk of falling was measured with a performance based (Mini-BESTest) and the fear of falling with a self-reported outcome measurement (ABC scale). They were assessed preoperatively, postoperatively and one year after the operation. Spearman correlations between the two assessments were performed in order to determine the strength and direction of their relationship.
Results: Forty-three people with Parkinson’s disease met the inclusion criteria for the study. The median Mini-BESTest score preoperatively was 21/28. Thirty-five per cent of the cohort were at a high risk of falling. After the operation the median score was 20/28 and 30% were at a high risk of falling. One year later, the median score was 23/28 with 33% of the people with Parkinson’s disease having a high risk of falling. Based on the ABC scale preoperatively, 36% were at a high risk of falling, after the operation 34% and one year later 29%. The median ABC scale scores were 78/100 preoperatively, 83/100 postoperatively and 81/100 one year after operation. There was no significant change in the risk of falling between the three measurement time points. At baseline and at the one-year assessment, the two measurements showed a fair correlation (ρ = 0.47, ρ = 0.49) and a moderate correlation (ρ = 0.58) postoperatively.
Conclusion(s): There was no statistically significant change in the risk of falling nor of the fear of falling after STN-DBS in this population. With the operation, seven out of 43 (16%) of people with Parkinson’s Disease changed in their risk of falling measured with the Mini-BESTest and 11 of 41 (27%) measured with the ABC scale, when taking the respective minimal detectable change of the outcome measure into consideration. The correlations between the measurements suggests that they measure slightly different aspects of the risk of falling. Increased prevalence of falls after DBS might be explained by a higher exposure to risk due to better mobility. People with Parkinson’s disease might find themselves in a new and unknown situation due to faster movement and changed biomechanics as a result of reduced rigidity and bradykinesia.
Implications: The results suggest that by itself STN-DBS has no effect - either positive or negative - on the risk of falling. Tailored physiotherapy may positively influence the potentially increased prevalence of falls after STN-DBS.
Funding, acknowledgements: This research was unfunded
Keywords: Parkinson’s disease, deep brain stimulation, falls
Topic: Neurology: Parkinson's disease
Did this work require ethics approval? Yes
Institution: Gesundheitsund Fürsorgedirektion des Kantons Bern, Kantonale Ethikkommission für die Forschung
Committee: Gesundheitsund Fürsorgedirektion des Kantons Bern, Kantonale Ethikkommission für die Forschung
Ethics number: 2018-01013
All authors, affiliations and abstracts have been published as submitted.
