Rastreio de Ocorrência de Quedas e Análise Retrospetiva numa População com Doença de Parkinson
DOI:
https://doi.org/10.25759/spmfr.300Palavras-chave:
Doença de Parkinson/complicações, Doença de Parkinson/reabilitação, Equilíbrio Postural, Quedas Acidentais/prevenção e controloResumo
Introdução: As quedas são comuns na doença de Parkinson aumentando a incapacidade e a morbidade. A participação em programas de reabilitação e a modificação de fatores de risco podem melhorar os resultados. Pretendeu-se caraterizar uma população com doença de Parkinson, nomeadamente a autoperceção do equilíbrio e a participação em programas de reabilitação e encontrar possíveis associações com a ocorrência de quedas.
Métodos: Estudo retrospetivo e transversal, compreendendo todos os doentes com doença de Parkinson de uma Unidade de Saúde Familiar. Foram definidos dois grupos, os que caíram e os que não caíram anteriormente. Os fatores sociodemográficos, a participação em programas de reabilitação, a pontuação na escala Activities-specific Balance Confidence (ABC-16) e outros fatores de risco foram colhidos através de questionário administrado por telefone e complementado com os registos clínicos. Foi realizada uma análise comparativa entre ambos os grupos, foi calculado o valor de corte para a pontuação da escala ABC-16 e foi realizada uma regressão logística para determinação do efeito das variáveis na probabilidade de ocorrência de quedas.
Resultados: Trinta e quatro doentes foram elegíveis após aplicação dos critérios de exclusão, dos quais 29,4% eram fisicamente ativos. No ano precedente, 41,2% realizaram programa de reabilitação e 18 reportaram pelo menos um episódio de queda. O modelo de regressão logística explicou 70% da variância das quedas reportadas (p < 0,005, sensibilidade 87%; especificidade 94%): a pontuação baixa na escala ABC-16 (OR: 0.94), a não participação em programas de reabilitação (OR: 15,3) e o género feminino (OR: 11,4) aumentaram a probabilidade de episódios de queda durante o ano precedente. Foi determinado o valor de corte de 63 para a pontuação da escala ABC-16.
Conclusão: A aplicação remota de um questionário incluindo a escala ABC-16 pode representar uma ferramenta de rastreio para avaliar o risco de queda na doença de Parkinson. O género feminino e a não participação em programas de reabilitação esteve associada a história de quedas. Estes achados enfatizam a necessidade de implementação de programas de prevenção de quedas nesses doentes.
Downloads
Referências
Pringsheim T, Jette N, Frolkis A, Steeves TD. The prevalence of Parkinson's disease: a systematic review and meta-analysis. Movement disorders : official journal of the Movement Disorder Society. 2014;29(13):1583-1590.
Ferreira JJ GN, Valadas A, Januário C, Silva MR, Nogueira L, et al. Estudo epidemiológico de avaliação da prevalência da doença de Parkinson em Portugal. Sinapse.
Delamarre A, Meissner WG. Epidemiology, environmental risk factors and genetics of Parkinson's disease. Presse Med. 2017;46(2 Pt 1):175-181.
Lees AJ, Hardy J, Revesz T. Parkinson's disease. Lancet (London, England). 2009;373(9680):2055-2066.
Jankovic J. Parkinson’s disease: clinical features and diagnosis. Journal of Neurology, Neurosurgery & Psychiatry. 2008;79(4):368.
Rogers MW. Disorders of posture, balance, and gait in Parkinson's disease. Clinics in geriatric medicine. 1996;12(4):825-845.
Morris ME, Iansek R, Matyas TA, Summers JJ. The pathogenesis of gait hypokinesia in Parkinson's disease. Brain : a journal of neurology. 1994;117 ( Pt 5):1169-1181.
Roemmich RT, Nocera JR, Vallabhajosula S, et al. Spatiotemporal variability during gait initiation in Parkinson's disease. Gait & posture. 2012;36(3):340-343.
Rogers MW, Kennedy R, Palmer S, et al. Postural preparation prior to stepping in patients with Parkinson's disease. Journal of neurophysiology. 2011;106(2):915-924.
Stack E, Ashburn A, Jupp K. Postural instability during reaching tasks in Parkinson's disease. Physiotherapy research international : the journal for researchers and clinicians in physical therapy. 2005;10(3):146-153.
Boonstra TA, van Kordelaar J, Engelhart D, van Vugt JP, van der Kooij H. Asymmetries in reactive and anticipatory balance control are of similar magnitude in Parkinson's disease patients. Gait & posture. 2016;43:108-113.
Dennison AC, Noorigian JV, Robinson KM, et al. Falling in Parkinson disease: identifying and prioritizing risk factors in recurrent fallers. American journal of physical medicine & rehabilitation. 2007;86(8):621-632.
Ashburn A, Stack E, Ballinger C, Fazakarley L, Fitton C. The circumstances of falls among people with Parkinson's disease and the use of Falls Diaries to facilitate reporting. Disability and rehabilitation. 2008;30(16):1205-1212.
Bloem BR, Grimbergen YA, Cramer M, Willemsen M, Zwinderman AH. Prospective assessment of falls in Parkinson's disease. Journal of neurology. 2001;248(11):950-958.
Idjadi JA, Aharonoff GB, Su H, et al. Hip fracture outcomes in patients with Parkinson's disease. American journal of orthopedics (Belle Mead, NJ). 2005;34(7):341-346.
Bloem BR, Hausdorff JM, Visser JE, Giladi N. Falls and freezing of gait in Parkinson's disease: a review of two interconnected, episodic phenomena. Movement disorders : official journal of the Movement Disorder Society. 2004;19(8):871-884.
Mak MK, Pang MY. Fear of falling is independently associated with recurrent falls in patients with Parkinson's disease: a 1-year prospective study. Journal of neurology. 2009;256(10):1689-1695.
Hely MA, Reid WG, Adena MA, Halliday GM, Morris JG. The Sydney multicenter study of Parkinson's disease: the inevitability of dementia at 20 years. Movement disorders : official journal of the Movement Disorder Society. 2008;23(6):837-844.
Ashburn A, Stack E, Pickering RM, Ward CD. Predicting fallers in a community-based sample of people with Parkinson's disease. Gerontology. 2001;47(5):277-281.
Gray P, Hildebrand K. Fall risk factors in Parkinson's disease. The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses. 2000;32(4):222-228.
Pickering RM, Grimbergen YA, Rigney U, et al. A meta-analysis of six prospective studies of falling in Parkinson's disease. Movement disorders : official journal of the Movement Disorder Society. 2007;22(13):1892-1900.
Latt MD, Lord SR, Morris JG, Fung VS. Clinical and physiological assessments for elucidating falls risk in Parkinson's disease. Movement disorders : official journal of the Movement Disorder Society. 2009;24(9):1280-1289.
Vestergaard P, Rejnmark L, Mosekilde L. Fracture risk associated with parkinsonism and anti-Parkinson drugs. Calcif Tissue Int. 2007;81(3):153-161.
Matinolli M, Korpelainen JT, Sotaniemi KA, Myllyla VV, Korpelainen R. Recurrent falls and mortality in Parkinson's disease: a prospective two-year follow-up study. Acta neurologica Scandinavica. 2011;123(3):193-200.
Paul SS, Canning CG, Sherrington C, Lord SR, Close JC, Fung VS. Three simple clinical tests to accurately predict falls in people with Parkinson's disease. Movement disorders : official journal of the Movement Disorder Society. 2013;28(5):655-662.
Paul SS, Canning CG, Song J, Fung VS, Sherrington C. Leg muscle power is enhanced by training in people with Parkinson's disease: a randomized controlled trial. Clinical rehabilitation. 2014;28(3):275-288.
Plotnik M, Giladi N, Dagan Y, Hausdorff JM. Postural instability and fall risk in Parkinson's disease: impaired dual tasking, pacing, and bilateral coordination of gait during the "ON" medication state. Experimental brain research. 2011;210(3-4):529-538.
World Health Organization. WHO Global Report on Falls Prevention in Older Age. Geneva, Switzerland: World Health Organization2008.
Talarska D, Strugała M, Szewczyczak M, et al. Is independence of older adults safe considering the risk of falls? BMC Geriatrics. 2017;17:66.
Lord SR. Visual risk factors for falls in older people. Age and ageing. 2006;35 Suppl 2:ii42-ii45.
Agmon M, Lavie L, Doumas M. The Association between Hearing Loss, Postural Control, and Mobility in Older Adults: A Systematic Review. Journal of the American Academy of Audiology. 2017;28(6):575-588.
Menz HB, Morris ME, Lord SR. Foot and ankle risk factors for falls in older people: a prospective study. The journals of gerontology Series A, Biological sciences and medical sciences. 2006;61(8):866-870.
Stanmore EK, Oldham J, Skelton DA, et al. Risk Factors for Falls in Adults With Rheumatoid Arthritis: A Prospective Study. Arthritis Care & Research. 2013;65(8):1251-1258.
Bergland A, Jarnlo G-B, Laake K. Predictors of falls in the elderly by location. Aging Clinical and Experimental Research. 2003;15(1):43-50.
Hong GR, Cho SH, Tak Y. Falls among Koreans 45 years of age and older: incidence and risk factors. Journal of advanced nursing. 2010;66(9):2014-2024.
Schlick C, Schniepp R, Loidl V, Wuehr M, Hesselbarth K, Jahn K. Falls and fear of falling in vertigo and balance disorders: A controlled cross-sectional study. Journal of vestibular research : equilibrium & orientation. 2016;25(5-6):241-251.
Seifer C, Kenny RA. The prevalence of falls in older persons paced for atrioventricular block and sick sinus syndrome. The American journal of geriatric cardiology. 2003;12(5):298-301; quiz 304-295.
McIntosh SJ, Lawson J, Kenny RA. Clinical characteristics of vasodepressor, cardioinhibitory, and mixed carotid sinus syndrome in the elderly. The American journal of medicine. 1993;95(2):203-208.
Oliveira PP, Fachin SM, Tozatti J, Ferreira MC, Marinheiro LP. Comparative analysis of risk for falls in patients with and without type 2 diabetes mellitus. Revista da Associacao Medica Brasileira (1992). 2012;58(2):234-239.
Chiarelli PE, Mackenzie LA, Osmotherly PG. Urinary incontinence is associated with an increase in falls: a systematic review. Australian Journal of Physiotherapy. 2009;55(2):89-95.
Holloway RG, Tuttle D, Baird T, Skelton WK. The safety of hospital stroke care. Neurology. 2007;68(8):550-555.
Kerse N, Flicker L, Pfaff JJ, et al. Falls, depression and antidepressants in later life: a large primary care appraisal. PloS one. 2008;3(6):e2423.
Evans JG. Drugs and falls in later life. Lancet (London, England). 2003;361(9356):448.
Tanaka M, Suemaru K, Ikegawa Y, Tabuchi N, Araki H. Relationship between the risk of falling and drugs in an academic hospital. Yakugaku zasshi : Journal of the Pharmaceutical Society of Japan. 2008;128(9):1355-1361.
Woolcott JC, Richardson KJ, Wiens MO, et al. Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Archives of internal medicine. 2009;169(21):1952-1960.
Amann GP. Programa Nacional de Prevenção de Acidentes. Projeto: COM MAIS CUIDADO - Prevenção de acidentes domésticos com pessoas Idosas. Manual de Apoio e Formulário. Lisboa
Deandrea S, Lucenteforte E, Bravi F, Foschi R, La Vecchia C, Negri E. Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis. Epidemiology. 2010;21(5):658-668.
Andlin-Sobocki P, Jonsson B, Wittchen HU, Olesen J. Cost of disorders of the brain in Europe. European journal of neurology. 2005;12 Suppl 1:1-27.
Elbaz A, Moisan F. Update in the epidemiology of Parkinson's disease. Current opinion in neurology. 2008;21(4):454-460.
Tomlinson CL, Patel S, Meek C, et al. Physiotherapy intervention in Parkinson’s disease: systematic review and meta-analysis. BMJ : British Medical Journal. 2012;345.
Keus SH, Munneke M, Nijkrake MJ, Kwakkel G, Bloem BR. Physical therapy in Parkinson's disease: evolution and future challenges. Movement disorders : official journal of the Movement Disorder Society. 2009;24(1):1-14.
Keus Sea. European Physiotherapy Guideline for Parkinson’s Disease. (KNGF/ParkinsonNet, 2014).
Shen X, Wong-Yu IS, Mak MK. Effects of Exercise on Falls, Balance, and Gait Ability in Parkinson's Disease: A Meta-analysis. Neurorehabil Neural Repair. 2016;30(6):512-527.
Mak MK, Wong-Yu IS, Shen X, Chung CL. Long-term effects of exercise and physical therapy in people with Parkinson disease. Nat Rev Neurol. 2017;13(11):689-703.
Powell LE, Myers AM. The Activities-specific Balance Confidence (ABC) Scale. The journals of gerontology Series A, Biological sciences and medical sciences. 1995;50A(1):M28-34.
Soares Branco P. Validação da Versão Portuguesa da “Activities-specific Balance Confidence Scale”. Revista da Sociedade Portuguesa de Medicina Física e de Reabilitação. 2010;19(2):20-5.
Soares Branco P. Determinação dos Pontos de Corte para Elevado Risco de Queda e Mobilidade Normal da Versão Portuguesa da Activities-Specific Balance Confidence (ABC) Scale. Revista da Sociedade Portuguesa de Medicina Física e de Reabilitação. 2013; v. 24, n. 2.
Araújo F, Ribeiro JLP, Oliveira A, Pinto C. Validação do Índice de Barthel numa amostra de idosos não institucionalizados. 2007.
Mahoney FI, Barthel DW. FUNCTIONAL EVALUATION: THE BARTHEL INDEX. Maryland state medical journal. 1965;14:61-65.
World Health Organization. Global Recommendations on Physical Activity for Health. 2010.
Wei F, Hester AL. Gender Difference in Falls among Adults Treated in Emergency Departments and Outpatient Clinics. Journal of gerontology & geriatric research. 2014;3:152.
Stevens JA, Sogolow ED. Gender differences for non-fatal unintentional fall related injuries among older adults. Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention. 2005;11(2):115-119.
Peel NM, Kassulke DJ, McClure RJ. Population based study of hospitalised fall related injuries in older people. Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention. 2002;8(4):280-283.
Duckham RL, Procter-Gray E, Hannan MT, Leveille SG, Lipsitz LA, Li W. Sex differences in circumstances and consequences of outdoor and indoor falls in older adults in the MOBILIZE Boston cohort study. BMC Geriatr. 2013;13:133.
Salva A, Bolibar I, Pera G, Arias C. Incidence and consequences of falls among elderly people living in the community. Medicina clinica. 2004;122(5):172-176.
Moniz-Pereira V, Carnide F, Ramalho F, et al. Using a multifactorial approach to determine fall risk profiles in portuguese older adults. Acta reumatologica portuguesa. 2013;38(4):263-272.
Todorov I, Del Missier F, Mäntylä T. Age-Related Differences in Multiple Task Monitoring. PloS one. 2014;9(9).
Johansson J, Nordstrom A, Nordstrom P. Greater Fall Risk in Elderly Women Than in Men Is Associated With Increased Gait Variability During Multitasking. Journal of the American Medical Directors Association. 2016;17(6):535-540.
Georgiev D, Hamberg K, Hariz M, Forsgren L, Hariz GM. Gender differences in Parkinson's disease: A clinical perspective. Acta neurologica Scandinavica. 2017;136(6):570-584.
Mak MK, Wong A, Pang MY. Impaired executive function can predict recurrent falls in Parkinson's disease. Archives of physical medicine and rehabilitation. 2014;95(12):2390-2395.
Cole MH, Rippey J, Naughton GA, Silburn PA. Use of a Short-Form Balance Confidence Scale to Predict Future Recurrent Falls in People With Parkinson Disease. Archives of physical medicine and rehabilitation. 2016;97(1):152-156.
Foongsathaporn C, Panyakaew P, Jitkritsadakul O, Bhidayasiri R. What daily activities increase the risk of falling in Parkinson patients? An analysis of the utility of the ABC-16 scale. Journal of the neurological sciences. 2016;364:183-187.
Fuzhong L, McAuley E, Fisher KJ, Harmer P, Chaumeton N, Wilson NL. Self-efficacy as a mediator between fear of falling and functional ability in the elderly. Journal of aging and health. 2002;14(4):452-466.
Mak MKY, Pang MYC, Mok V. Gait Difficulty, Postural Instability, and Muscle Weakness Are Associated with Fear of Falling in People with Parkinson's Disease. Parkinson's Disease. 2012;2012:901721.
Adkin Allan L, Frank James S, Jog Mandar S. Fear of falling and postural control in Parkinson's disease. Movement Disorders. 2003;18(5):496-502.
Pereira CB, Kanashiro AK, Maia FM, Barbosa ER. Correlation of impaired subjective visual vertical and postural instability in Parkinson's disease. Journal of the neurological sciences. 2014;346(1-2):60-65.
Bryant MS, Rintala DH, Hou JG, Protas EJ. Relationship of falls and fear of falling to activity limitations and physical inactivity in Parkinson's disease. Journal of aging and physical activity. 2015;23(2):187-193.
Sparrow D, DeAngelis TR, Hendron K, Thomas CA, Saint-Hilaire M, Ellis T. Highly Challenging Balance Program Reduces Fall Rate in Parkinson Disease. Journal of neurologic physical therapy : JNPT. 2016;40(1):24-30.
Protas EJ, Mitchell K, Williams A, Qureshy H, Caroline K, Lai EC. Gait and step training to reduce falls in Parkinson's disease. NeuroRehabilitation. 2005;20(3):183-190.
Morris ME, Menz HB, McGinley JL, et al. A Randomized Controlled Trial to Reduce Falls in People With Parkinson's Disease. Neurorehabil Neural Repair. 2015;29(8):777-785.
Paul SS, Dibble LE, Peterson DS. Motor learning in people with Parkinson's disease: Implications for fall prevention across the disease spectrum. Gait & posture. 2018;61:311-319.
Canning CG, Paul SS, Nieuwboer A. Prevention of falls in Parkinson's disease: a review of fall risk factors and the role of physical interventions. Neurodegenerative disease management. 2014;4(3):203-221.
Farag I, Sherrington C, Hayes A, et al. Economic evaluation of a falls prevention exercise program among people With Parkinson's disease. Movement disorders : official journal of the Movement Disorder Society. 2016;31(1):53-61.
Downloads
Publicado
Como Citar
Edição
Secção
Licença
Os manuscritos devem ser acompanhados de declaração de originalidade, Autoria e de cedência dos direitos de propriedade do artigo, assinada por todos os Autores.
Quando o artigo é aceite para publicação é obrigatória a submissão de um documento digitalizado, assinado por todos os Autores, com a partilha dos direitos de Autor entre Autores e a Revista SPMFR, conforme minuta:
Declaração Copyright
Ao Editor-chefe da Revista da Sociedade Portuguesa de Medicina Física e Reabilitação
O(s) Autor(es) certifica(m) que o manuscrito intitulado:
____________________________________________________________________ (ref.Revista da SPMFR_________) é original, que todas as afirmações apresentadas como factos são baseados na investigação do(s) Autor(es), que o manuscrito, quer em parte quer no todo, não infringe nenhum copyright e não viola nenhum direito da privacidade, que não foi publicado em parte ou no todo e que não foi submetido para publicação, no todo ou em parte, noutra revista, e que os Autores têm o direito ao copyright.
Todos os Autores declaram ainda que participaram no trabalho, se responsabilizam por ele e que não existe, da parte de qualquer dos Autores conflito de interesses nas afirmações proferidas no trabalho.
Os Autores, ao submeterem o trabalho para publicação, partilham com a Revista da SPMFR todos os direitos a interesses do copyright do artigo.
Todos os Autores devem assinar
Data:
Nome(maiúsculas)
Assinatura
Relativamente à utilização por terceiros a Revista da SPMFR rege-se pelos termos da licença Creative Commons “Atribuição – uso Não-Comercial – Proibição de Realização de Obras derivadas (by-nc-nd)”.
Após publicação na Revista SPMFR, os Autores ficam autorizados a disponibilizar os seus artigos em repositórios das suas instituições de origem, desde que mencionem sempre onde foram publicados.
OS AUTORES DEVERÃO SUBMETER UMA DECLARAÇÃO DE CONTRIBUIÇÃO / CONTRIBUTORSHIP STATEMENT INDICANDO O TIPO DE PARTICIPAÇÃO DE CADA AUTOR NO ARTIGO. Mais informações: https://authors.bmj.com/policies/bmj-policy-on-authorship/
