TABLE 1.
Summarized results of included studies
| Study, year, country, database used | Inclusion criteria | Study subjects | Outcome measures | NOS score a | Falls | Fear of falls | Complications of falls or fear of falls | Prevention and management |
|---|---|---|---|---|---|---|---|---|
| Gazibara T et al. 2014, Serbia, Neurology Clinic, Clinical Center of Serbia in Belgrade 2011–2012 | Age from 22 to 83 with PD. MMSE ≥ 24, walk independently for 10 m, stand for 90 s | 180 participants with PD, | Detailed interviews about falls information |
S*** C** O** |
Outside (57.2%), morning (53.9%), outside tripping OR: 7.90(3.21‐19.39), indoors lower extremity weakness β: 0.20(0.05‐0.72) and loss balance β: 0.19(0.05‐0.73) | NA | Soft‐tissue contusion (71.8%); fractures (12.7%) | Additional spatial visualization; using of cane; Particular prevention programs for PD at home and outside |
| Franzén E et al. 2016, Stockholm, Conradsson, Löfgren, Ståhle, Hagströmer, & Franzén, 2012 | PD; MMSE ≥ 24 | 89 patients with PD; Age from 61 to 87 | Structure questions, questionnaires and clinical assessments of falls; fear of falls |
S** C** O** |
Concerning about falling (48%) | Depression symptoms (β = 0.40) | NA | Focus on depressive symptoms, balance deficits, and mobility devices in rehabilitation programs of FOF |
| Paul SS et al. 2017, Australia, NSW Admitted Patients Data Collection 2005–2013 | PD and falls | 8487 fallers with PD | ICD10: S00‐T75 and T79 |
S*** C** O*** |
PD patients (2.5%); length of stay longer (M = 9d); indoor fall (44%) | NA | Fracture (35%); dementia (28.8%); comorbid (56.1%) | Early intervention to maintain mobility and reduce falls |
| Youn J et al. 2017, Korea, Movement Disorders Clinic at Samsung Medical Center, 2014–2015 | PD and falls | 45 participants with forward fallers, 17 with non‐forward fallers | forward PD fallers and non‐forward PD fallers |
S*** C** O*** |
Forward falls (72.6%) non‐forward falls (27.4%). Freeze of gait is frequency in forward falls | NA | NA | Prevention strategies focusing on postural instability; Using various scales can check balance problems in PD |
| Friedman SM et al. 2002, USA, Health Care Financing Administration | PD; MMSE ≥ 18 | 2,212 participants, aged from 65 to 84 | Falls and fear of falls |
S*** C** O*** |
Who with no FOF but falls at baseline were more likely to fear at follow‐up OR: 1.97(1.46‐2.64); cut back on activities OR: 2.51(1.52‐4.14) | Who with FOF were more likely to fall than who without fear OR: 2.22(1.65‐2.98) | Female, older age, worse GHQ (p < 0.05) | Identify high‐risk groups; White race, female, history of stroke, sedative use, FOF were predictors; Confirm FOF is useful assessment of risk |
| Balash Y et al. 2005, Israel, Clinic of the Movement Disorders Unit of the Tel Aviv Sourasky Medical Center 2002 | PD and falls | 350 non‐demented PD patients. | falls |
S*** C** O*** |
Advanced PD (p < 0.001); poor health (p = 0.002); duration of stance reduced (p < 0.001); Timed Up and Go time shorter in non‐falls (p < 0.001) | NA | Urinary incontinence OR: 1.95(1.17‐3.23) | Urinary incontinence can used for identify patients; Osteoporosis and treatment of osteopenia in elderly PD |
| Grimbergen YA et al. 2013, UK, database is not mentioned | PD and falls | 74 PD patients | Falls and fear of falls |
S*** C** O*** |
Balance confidence β = 0.28; Fall frequency β = 0.13 | FOF β = 0.34; FOF (R2 = 0.53) | NA | Management to improve quality of life at prevention of falls and assessment and treatment of FOF; Prevention strategies focusing on postural instability, cognitive and emotional domains |
| Allcock LM et al. 2009, UK, General Practitioners outside the community screening | PD and falls | 87 PD patients | Falls and fear of falls |
S*** C** O** |
Fall at least once (63%); falling twice or more (43.3%); accidental causes (38.9%); postural instability or dizziness (57.4%); | Continuity of attention reduced (p = 0.03) | Soft tissue injuries (81%) | Focus on cardiovascular and gait and balance orientated treatments and strategies to improve cognition |
| McKay JL et al. 2018, USA, community‐dwelling individuals 2011–2015 | PD and falls | 65 patients with PD and 73 normal | Falls |
S*** C** O** |
Falls (52%); impaired set shifting OR:1.29(1.03‐1.60); FOG (69%) | NA | NA | Set shifting may therefore be useful to include in fall risk assessments in older adults with and without PD |
| Gazibara T et al. 2016a, Serbia, Department of Movement Disorders, Neurology Clinic | PD and falls; walking for at least 10 m and standing for at least 90 s | 120 PD patients | Falls |
S** C** O** |
Indoors fall (61.0%); outdoors falls (68.3%); Slipping is strongly associated with outdoor falls Indoor falls were mostly preceded by postural instability, lower extremity weakness, vertigo | NA | Fractures (4.3%) about hip fracture and redial fracture. | Using of cane; Elevating feet when crossing obstacles more than perceiving; Assess joint effect of potential falls factors; Emphasizing on balance recovery and objects in environment |
| Hunter H et al. 2018, UK, ICICLE‐PD | PD and falls | 121 PD patients | Falls |
S** C* O** |
Fall diary to collect fall information | NA | Falls diary data reduced (n = 62) | Longitudinal use of falls diaries is feasible; Making personal monitoring |
| Hiorth YH 2014, Norway, Rogaland County, Western Norway | PD and falls | 211 PD patients | Falls |
S** C** O** |
Disease‐specific gait and axial impairments were the major risk factors for future falls in non‐fallers at baseline | NA | NA | specific education of patients and caregivers in using compensatory strategies; Early treatment strategies of PD are important |
| Gazibara T et al. 2017, Serbia, Department of Movement Disorders, Neurology Clinic 2011–2012 | PD and falls | 120 PD patients without falls in past 6 months | Falls |
S** C** O** |
Fall at least one times (35%); recurrent falls (54.7%); near‐falls (93.5%) | NA | NA | engaging in tailored physical exercise may have a favorable effect on occurrence of near‐fall episodes; Focusing on balance maintenance when experiencing freezing of gait could potentially be useful in reduction of near‐falls |
| Kiesmann M et al. 2020, France, EVAMAR‐AGEX | PD and falls | 79 PD patients | Falls within 6 months |
S** C** O** |
Traumatic (12%); single fallers (8%); zero fallers (34%) | NA | Hallucination (OR = 7.35); history of falls (OR = 11.78) | encouraging elder to maintain his or her cognitive abilities and physical activity focused on postural stability and posture |
| Dibble LE et al. 2006, USA, The University of Utah Rehabilitation and Wellness Clinic | PD and falls | 45 PD patients aged 39 to 90 | The individual unintentionally came to rest on the ground or other level |
S*** C** O** |
FRT (27.43 cm), BBS (50.20), DGI (19.92), TUG (11.67), CTUG (16.48) | NA | NA | Recode number of falls; More accurate predictive ability for falls in persons with PD |
| Hoskovcová M et al. 2015, Czech Republic |
PD and falls UK PD brain bank criteria Without a walking aid |
45 PD patients | Falls |
S** C** O** |
Fall one or more (60%) | NA | NA | Daylong monitoring of gait; Instrumented testing of gait in the OFF state |
| Moreno CM et al. 2015, Germany, database is not mentioned | PD and falls Hoehn & Yahr scale > 3 | 25 young PDs (12 fallers, 13 non‐fallers) | Falls |
S** C** O* |
Young PDs with an increased falling risk may benefit from leg‐extensors strengthening and stability training. | NA | NA | Focusing on leg‐extensors strengthening as well as on exercising the mechanisms; Developing appropriate exercise therapy |
| Gazibara T et al. 2016b, Serbia, the Department of Movement Disorders, Neurology Clinic, Clinical center of Serbia | PD and falls; walk independently for 10 m; statically stand for at least 90 s | 120 PD patients | Falls |
S** C** O*** |
Recurrent fallers (54.8%); outdoors falls in recurrent fallers (p = 0.017); slipping in single falls (36.8%); posture instability (33.0%); lower extremity weakness (p= 0.023) | NA |
Common: soft‐tissue contusion; few: radial fracture. |
Assess joint effect of potential falls factors; Enrolling in fall prevention programs; Guiding physical exercise is important |
| D'Cruz N et al. 2020, Belgium, the Movement Disorders Clinic of the University Hospital in Leuven | PD patients walk independently for at least 10 m | 60 PD patient without freezing of gait | Falls |
S** C** O** |
Conversion to FOG was predicted mainly by objective and clinical measures of motor dyscontrol | NA | NA | Focusing on motor dyscontrol apparent in repetitive gait and non‐gait tasks such as finger tapping, toe tapping and stepping in place; Screening FOG conversion risk |
| Ashburn A et al. 2008, UK, database is not mentioned | PD; independently mobile; Living at home; falls in 12 months | 142 PD patients | Falls |
S*** C** O*** |
Home falls (80%); other falls (12%); bedroom falls (30%); loss of balance (69%); setting off too quickly after standing (11%) | NA | 8 fallers fractures; 4 X‐ray; 3 need assistance. | Assisting individuals to deal with hazards cognitively and physically; Gait re‐education in PD must incorporate more than straight lines forward; Importance of cognitive; Falls diaries |
| Mark D et al. 2009, Australia, database is not mentioned |
PD; MMSE ≥ 24; independently walk; UK PD Brain Bank criteria |
130 PD patient | Falls |
S*** C** O** |
Falls at least once (45%); history of falls (P < 0.001); FOG (p= 0.004) | NA | Injurious falls (25%); 3 hip fractures, 1 radial fracture, and 1 tibial fracture | Focus on increased age, poor contrast sensitivity, slower cadence and TUG times, postural hypotension, bradykinesia, use of multiple medications, and PD‐specific factors. |
| Danielle PL et al. 2019, Brazil, the Movement Disorders Clinic in Fortaleza | PD patients; UK PD Brain Bank criteria | 218 PD patients | Falls |
S** C** O** |
Disease duration, modified HY stage, SE ADL score, LED, probable sarcopenia and positive SARC‐F (SARC‐F+) were associated with falls | NA | NA | Focus on sarcopenia in the older adults; Reduced quality of life; High‐protein diet and resistance exercise training. |
| Silvia DD Et Al. 2020, UK, V‐TIME Study | PD; walk for 5 m; on stable medication, self‐reported 2+ falls within 6 months | 282 fallers (109 older fallers, 19 MCI, 62 PD) | Falls |
S** C* O** |
PD falls 2 times for every 100k steps; FRA index more than other 2 groups (p= 0.043) | NA | NA | FRA index a preliminary but important step; V‐TIME intervention successfully reduced falls risks |
| Maria H et al. 2020, Sweden, Home and Health in People Ageing with PD (HHPD) | PD; mSADDE score; | 151 PD patients (mean = 68±8.8 y) | Falls |
S** C** O** |
Fall‐related activity avoidance (16% increased); concerns about falling (β = 0.589); | NA | NA | Activity avoidance can be a sound strategy in hazardous circumstances; Pain is a common symptom in PD adverse outcomes |
| Serene SP et al. 2014, Australia, private neurology clinics | PD ;age ≥ 40, MMSE ≥ 24; walk independently | 205 PD participants | Falls |
S*** C* O** |
Fall at least once (59%); freezing of gait (RR = 1.24); dyskinesia (RR = 1.14); stability (RR = 1.22); repeated sit to‐stand (RR = 1.19), fast walking speed (RR = 0.84); pull test (RR = 1.18) | NA | NA | Falls history probably represents a composite measure of individual risk factors; Impaired balance and cognition are important risk factors |
| Pattamon P et al. 2020, Thailand, Chulalongkorn Centre of Excellence for Parkinson's Disease | PD; H&Y stage 1–4; MMSE ≥ 21 | 305 PD patients | Having a history of at least one fall |
S** C* O** |
Faller (32%); recurrent fallers (19%); Model (sweep floor, reaching on tiptoes, walking in a crowded mall) |
NA | NA | Determining modifiable predictors of falling; Ranking high‐risk activities as the strongest predictors of falls/recurrent falls |
| Chayanin F et al. 2016, Japan, Chulalongkorn Centre of Excellence for Parkinson's Disease | PD; MMSE ≥ 24; | 184 PD patients and 52 normal people | Infrequent fallers; Frequent fallers |
S** C** O** |
HY stage higher (p < 0.001); ABC‐16 scores lower (p < 0.001); Walk on slippery sidewalks; Not holding rails on escalator; Bumped while walking in a crowd; Standing on chair to reach something | NA | NA | Activities that involved movement switching in the vertical orientation are significant predictors; Proper use of assisted devices |
| Tatjana G et al. 2017, Serbia, the Department of Movement Disorders, Neurology Clinic, Clinical Center of Serbia in Belgrade | PD; UK PD Brain Bank; MMSE ≥ 24; walk independently for 10 m and stand for 90 s | 120 PD patient | Falls and fear of falls |
S*** C** O** |
NA | FES scores higher (22.9%); Taking a bath or shower is the lowest level of confidence | NA | Installing hand rails, insert bathtub chairs and/or rubber mats; Enhancing confidence |
| Yaroslav W et al. 2010, Germany, Movement Disorders Outpatient Departments of University Hospitals 2003–2004 | PD; UK PD Brain Bank criteria | 100 PD patients | Health‐economic data |
S** C* O** |
Falling is related with total costs (p < 0.05) | NA | NA | Falls is additional factors increasing PD‐related costs; Evaluating the economic burden of PD |
| Taylor C et al. 2017, Canada, Ambulosono walking program | PD; step‐in‐place 5 m; Non‐dementia | 11 PD patients | H & Y; questionnaires |
S** C** O* |
Training effect (p= 0.047) | NA | NA | Easy and safe home‐based rehabilitation approach that may offer benefit to improving DT |
| Emma S et al. 2018, UK, Parkinson's UK (a UK charity) in Southampton | PD | 24 PD patients involved | Sensor data of trails |
S** C** O* |
Recalling repeated falls (21%); fall performances: cautious (19%), unstable (5%); Rise‐to‐Walk generated most near‐falls | NA | NA | Wearable sensors can detect subtle instability and might be a useful adjunct |
| Nader N et al. 2019, USA, database is not mentioned | PD | 18 participants with PD | Sensors of freezing of gaits. |
S** C* O** |
156 FOG in 18.4 min | NA | NA | Machine learning methods; Sensors detect FOG episodes, and the effects of cueing in ambient environments |
| Steve W P et al. 2016, UK, The North Tyneside Community Falls Prevention Service | PD; walk independently for 10 m | 35,288 PD participants with 60+ age. | Falls and fear of falls |
S*** C** O** |
NA | Fear of falls (n = 2,448) | NA | NTCFPS was highly effective in finding individuals with falls, syncope, and dizziness symptoms; Potential clinical and health economic effect |
| Tara M et al. 2015, New Zealand, New Zealand Brain Research Institute database | PD; NFOGQ (having FGO); MMSE ≥ 24 | 21 PD participants | Falls and fear of falls |
S** C** O*** |
Fall rate between 2 groups:1.22 (0.45‐3.26); adjusted 3.21(1.39‐9.38) | Worried about falling (17%); worried less about falling (39%); | NA | Capturing the difficulties experienced by patients in everyday life or their opinions on treatment acceptability and personal improvements |
| Daphne J et al. 2018, New Zealand, Leiden University Medical Center | UK PD Brain Bank clinical diagnostic criteria; age ≥ 18; stand unsupported for 20s+ | 30 PD patients and 30 controls | Tests of gait |
S** C** O** |
Walking speed, step length and stride length significant | NA | NA | It seems fair to conclude that the IWW is of added value in people with PD when assessing walking ability |
| Daniel SP et al. 2020, USA, database is not mentioned | PD; age ≥ 55; no other neurological disease and orthopedic injuries | 16 PD patients and 14 controls | Cognitive, neuromuscular, and protective stepping |
S** C** O** |
Muscle onset (p= 0.003), step length (p= 0.011), latency (P < 0.001), and step width (p= 0.001) | NA | NA | Part of population may prioritize cognition over gait, known as a “posture second” strategy; Single‐task protective stepping can be improved through practice in people with PD |
| Davide C et al. 2019, Italy, NEUROFALL group 2015–2016 | PD; walk 10 m independently | 113 patients evolved (32 PD) | Telephone contacts for falls information |
S** C** O** |
Fall in the past 6 months; number of falls in the education group were evenly distributed; higher number of falls in subjects with higher level of participation | NA | NA | Education program improved ability to carry out activities and decreased participation restrictions without a concomitant increase of number of falls |
| Colleen GC et al. 2015; Australia, Sydney and regional and rural New South Wales | PD; age ≥ 40; walk independently; stable medication intake for 2 w; fall at least once in 1 y | 231 PD patients | Falls |
S*** C** O** |
Exercise group compared control group (IRR = 0.73, p= 0.18); 69% reduction in falls in the exercise group; No significant interaction effect between fall history or physical function on rate of falls | NA | NA | Minimally supervised exercise programs aimed at reducing falls in people with PD should be implemented early in the disease process |
| Jennifer L et al. 2012, Australia, clinics and rehabilitation centers in Melbourne | PD; be able to walk; MMSE ≥ 24 | 210 participants | Mobility, activity limitations, and quality of life. |
S** C** O** |
Recurrent falls (64%); after intervention: 19 person falls 3–9 times,7 falls 10+ times | NA | Arthritis (44%); cancer or heart disease (23%) | Increased confidence might increase activity or risk taking and result in further falls; Strategy training and strength training can be safely implemented in a community‐based sample of people with idiopathic PD |
| Juliana M F et al. 2019, Brazil, database is not mentioned | PD; clock test > 4 | 9 PD older | After the booklets and games, creating the codes |
S* C* O* |
NA | NA | NA | care reduce the emotional, social and physical overload; Physiotherapy and physical activity can improve motor symptoms |
| Changhong Y et al. 2020, Korea, database is not mentioned | PD; H&Y stage 1–3; MMSE ≥ 24 | 23 participants | Test scores |
S** C** O** |
Step test (ES = 0.341); TUG test (ES = 0.299); AP (ES = 0.293); ML (ES = 0.299); step length (ES = 0.332), step velocity (ES = 0.301), and toe‐clearance height (ES = 0.285) | NA | NA | Exercise program may improve their overall movement; Progressive resistance exercise program |
| Tatjana G et al. 2015, Serbia, Department of Movement Disorders, Neurology Clinic | PD; able to walk; stand for 90 s | 42 PD patients | Indoor falls and outdoor falls |
S** C** O** |
Indoor falls (61%); outdoor falls (68%); falls dominantly occurred in daytime; outdoors (tripping, slipping) | NA | NA | Causes of falls involved both extrinsic and intrinsic factors; Using of cane; Emphasizing on balance recovery and negotiation of objects in environment |
| Laura A et al. 2020, USA, database is not mentioned | PD; age ≥ 18; sMMSE ≥ 4 | 18 PD patients | Adverse events; FPMQ; FES‐I |
S** C** O** |
Falls (n = 10); fall decreased (elimination of recurrent fallers); 6 home falls; 4 community falls; FPMQ & FPSS had interaction between assessment time and practice | NA | NA | Learning about body awareness in yoga may have been more mindful of fall prevention; Yoga decreased the number of recurrent fallers |
| Natalie E et al. 2015, Australia, database is not mentioned | PD; MMSE ≥ 24; age ≥ 40; walk independently | 115 PD participants | Adherence information of exercise; FES‐I; SF‐6D |
S** C** O** |
Adherence (72%); bodily pain (86%); less bodily pain (more SF‐6D) | NA | NA | Effective treatment of pain could therefore improve adherence to exercise |
| Tatjana G et al. 2016, Serbia, the Department of Movement Disorders, Neurology Clinic, Clinical Center | PD; walk for 10 m; stand for 90 s | 300 PD patients | H&Y scores; UPDRS; FES; SADS; NFOG; HAMD; HAMA |
S** C** O** |
Recurrent fallers (19.2%); single fallers (45.2%); FES, SADS, NFOG, HAMD, HAMA positively correlated. | NA | NA | Frequent falls report less fear of falling as compared with infrequent fallers; Worse motor performance at baseline were more likely to experience recurrent falls |
| Kim C S et al. 2019, UK, National Health Service hospitals and clinics in UK | PD; Residuals; UK Brain Bank criteria; MMSE ≥ 24 | 474 PD participants | Falls; fractures; near falling; CST; GDS; FES; NFIG |
S** C** O** |
PDSAFE Near falling compared to control group (OR = 0.67) ;better balance (p = 0.026); better CST (p= 0.041); repeat falls (p = 0.111); rate of falling (p = 0.088) | NA | NA | Personalizing plan; Individual motivation; Integrating their training into everyday functional tasks |
| Emma L S et al. 2013, UK, geriatrician's clinic in UK | PD | 255 PD questionnaires | Falls information (where, what, why, how, then) |
S* C** O** |
Single fallers(n = 19), recurrent falls(n = 86), very frequent fallers (n = 31); unfamiliar building (38%); during walking (52%); tripping (24%) | NA | Hurt (40%); immediate healthcare (16%) | Teaching them how to get up alone; Hypervigilance; Taking care to avoid trips; Sensitivity of fatigue |
FOF = fear of falls; FOG = freezing of gait; PD = Parkinson's disease.
a
Scale domains: S selection of study groups, C comparability, O outcome assessment.