Abstract
INTRODUCTION
In the recent falls guidelines, multidomain interventions are recommended for people with Parkinson’s disease (PwPD)[1]. Walking aids improve local balance and stability, increase confidence and reduce mechanical effort associated with walking[2], however walking aid use is associated with recurrent falls in PD[3]. This study aimed to understand pre-fall activity and environmental fall risk in fallers and the differences associated with walking aid use.
METHODS
An online survey was developed to evaluate retrospective falls in adults ≥60y. 117 PwPD responded to the survey. The survey covered basic descriptors, walking aid use, fall history (2y) and contextual information about falls.
RESULTS
48 PwPD used a walking aid and of those 43 (90%) had fallen (PDfaller+AID). 69 PwPD did not use a walking aid and of those 36 (52%) had fallen (PDfaller-AID). Results are reported for PDfaller+AID and PDfaller-AID. The groups were similar in age and sex. Fear of falling (Short FES-I) was significantly higher in PDfaller+AID (p<0.001).
For PDfaller+AID, the top three pre-fall activities were: turning; walking; and moving too quickly. For PDfaller-AID, the top three pre-fall activities were: turning; moving too quickly; and bending down. For both groups, the top three home environmental risk factors were: objects on the floor; slope/uneven surface; and steps/stairs.
77% of PDfaller+AID were not using their walking aid at the time of the fall and most commonly reported tripping over the door trim/ threshold compared to steps/stairs for PDfaller+AID who were using their walking aid.
CONCLUSION
Holistic approaches targeting gait and balance in combination with home modifications are required. Despite being prescribed a walking aid, the majority of PDfaller+AID were not using it at the time of the fall. Barriers to using walking aids in the home environment that should be explored.
[1] Montero-Odasso 2022 PMID:36178003 [2] Cetin 2010 PMID:20674533 [3] Canning 2014 PMID:25095816
Comments
Question
Hello. Thank you for presenting your work. What difference was there between walking aid v non-walking aid users with regards balance assessment, such as Tinetti score? What reasons were there for people with walking aids falling more at thresholds and what type of walking aid was being used at the time that people fell?
Response to Alasdair
Thanks Alasdair - great question.
We do not have data on participants self-reported balance ability unfortunately, however we did obtain a measure of fear of falling (FOF; Short Falls Efficacy scale; sFES) which confirmed that PD fallers [+AID] had a higher FOF compared to PD fallers [-AID] and this was statistically significant (p<0.001).
PD fallers [+AID] sFES median=18 (range 10-28) vs. PD fallers [-AID] sFES median=14 (range 7-23).
The majority (80%) of PD fallers [+AID] used a cane/ walking stick/ crutch (n=20, 47%) or walker/ rollator (n=16, 37%). Further analysis exploring
environmental risk factors for PD fallers depending on walking aid type has not been completed yet - however, we agree this will help to further tease out practical recommendations for building planning/ design, community healthcare services and occupational therapists.
We also asked respondents about their living arrangements, i.e. whether they lived in a house, bungalow etc. as we consider this may be an important factor to consider. A larger proportion of PD fallers [+AID] lived in a bungalow. Further analysis will explore other influential factors that were collected as part of the survey including polypharmacy and co-morbidities.
Thank you for your poster,…
Thank you for your poster, were you able to discriminate between walking aid types within your data?
Response to Sam
Thanks Sam, great question! The majority (80%) of PD fallers [+AID] used a cane/ walking stick/ crutch (n=20, 47%) or walker/ rollator (n=16, 37%). Further analysis exploring environmental risk factors for PD fallers depending on walking aid type has not been completed yet - however, we agree this will help to further tease out practical recommendations for community healthcare services and occupational therapists.
improve mobility aid use
Thank you for your poster, it is very informative. Did you explore how to improve compliance with walking aids to reduce falls in patients?
Response to Hannah
Thanks Hannah, very interesting question! In this nationwide survey, we did not explore compliance with using the walking aid. I suspect that there are environmental factors (as well as other factors) influencing the use of walking aids at home. We know that individuals often use items of their home environment as a substitute walking aid, however this may leave individuals vulnerable to imbalance and falls in areas of the house for which there are less items to hold onto. We were also interested in this and have recently completed a mixed methods review of the literature exploring the barriers and facilitators to home modifications which could provide additional support when individuals do not have their walking aid with them.
Question
This is really interesting thank you. I understand it was an online questionnaire. Where participants given advice on how to reduce their falls risk as a result of their responses?
Response to Anna
Thank you for your positive comment Anna! Participants responses were anonymous so unfortunately it was not possible to further interact with participants after they had completed the survey. However, this approach did allow us to canvas opinions from a large sample of people with Parkinson's. We will use these findings to provide practical insights and recommendations for walking aid use and inclusive house design. Despite walking aids being prescribed, the vast majority of participants were not using their walking aid at the time of the fall - we need to understand why this was the case and how walking aids can be designed for practical use in daily life.
very good
very good
Response to Salah
Thank you Salah!