Dual tasking with the timed "up & go" test improves detection of risk of falls in people with Parkinson disease.

Autor: Vance RC; R.C. Vance, PT, MSc, Physiotherapy Department, Beaumont Hospital, Beaumont Road, Dublin 9, Leinster, Ireland, and School of Physiotherapy, Royal College of Surgeons, 123 St Stephen's Green, Dublin 2, Dublin, Leinster, Ireland. roisinmoloney@beaumont.ie., Healy DG; D.G. Healy, MD, PhD, Neurology Department, Beaumont Hospital., Galvin R; R. Galvin, PT, PhD, School of Physiotherapy, Royal College of Surgeons., French HP; H.P. French, PT, PhD, School of Physiotherapy, Royal College of Surgeons.
Jazyk: angličtina
Zdroj: Physical therapy [Phys Ther] 2015 Jan; Vol. 95 (1), pp. 95-102. Date of Electronic Publication: 2014 Aug 21.
DOI: 10.2522/ptj.20130386
Abstrakt: Background: Falls are a common and disabling feature of Parkinson disease (PD). Early identification of patients at greatest risk of falling is a key goal of physical therapy assessment. The Timed "Up & Go" Test (TUG), a frequently used mobility assessment tool, has moderate sensitivity and specificity for identifying fall risk.
Objective: The study objective was to investigate whether adding a task (cognitive or manual) to the TUG (TUG-cognitive or TUG-manual, respectively) increases the utility of the test for identifying fall risk in people with PD.
Design: This was a retrospective cohort study of people with PD (N=36).
Methods: Participants were compared on the basis of self-reported fall exposure in the preceding 6 months (those who had experienced falls ["fallers"] versus those who had not ["nonfallers"]). The time taken to complete the TUG, TUG-cognitive, and TUG-manual was measured for both groups. Between-group differences were calculated with the Mann-Whitney U test. The discriminative performance of the test at various cutoff values was examined, and estimates of sensitivity and specificity were based on receiver operating characteristic curve plots.
Results: Fallers took significantly longer than nonfallers (n=19) to complete the TUG under all 3 conditions. The TUG-cognitive showed optimal discriminative performance (receiver operating characteristic area under the curve=0.82; 95% confidence interval [CI]=0.64, 0.92) at a cutoff of 14.7 seconds. The TUG-cognitive was more likely to correctly classify participants with a low risk of falling (positive likelihood ratio=2.9) (<14.7 seconds) and had higher estimates of sensitivity (0.76; 95% CI=0.52, 0.90) than of specificity (0.73; 95% CI=0.51, 0.88) at this threshold (negative likelihood ratio=0.32).
Limitations: Retrospective classification of fallers and nonfallers was used.
Conclusions: The addition of a cognitive task to the TUG enhanced the identification of fall risk in people with PD. The TUG-cognitive should be considered a component of a multifaceted fall risk assessment in people with PD.
(© 2015 American Physical Therapy Association.)
Databáze: MEDLINE
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