Comparison of the Fullerton Advanced Balance Scale, Mini-BESTest, and Berg Balance Scale to Predict Falls in Parkinson Disease

Abstract

Background The correct identification of patients with Parkinson disease (PD) at risk for falling is important to initiate appropriate treatment early. Objective This study compared the Fullerton Advanced Balance (FAB) scale with the Mini-Balance Evaluation Systems Test (Mini-BESTest) and Berg Balance Scale (BBS) to identify individuals with PD at risk for falls and to analyze which of the items of the scales best predict future falls. Design This was a prospective study to assess predictive criterion-related validity. Setting The study was conducted at a university hospital in an urban community. Patients Eighty-five patients with idiopathic PD (Hoehn and Yahr stages: 1–4) participated in the study. Measurements Measures were number of falls (assessed prospectively over 6 months), FAB scale, Mini-BESTest, BBS, and Unified Parkinson's Disease Rating Scale. Results The FAB scale, Mini-BESTest, and BBS showed similar accuracy to predict future falls, with values for area under the curve (AUC) of the receiver operating characteristic (ROC) curve of 0.68, 0.65, and 0.69, respectively. A model combining the items “tandem stance,” “rise to toes,” “one-leg stance,” “compensatory stepping backward,” “turning,” and “placing alternate foot on stool” had an AUC of 0.84 of the ROC curve. Limitations There was a dropout rate of 19/85 participants. Conclusions The FAB scale, Mini-BESTest, and BBS provide moderate capacity to predict “fallers” (people with one or more falls) from “nonfallers.” Only some items of the 3 scales contribute to the detection of future falls. Clinicians should particularly focus on the item “tandem stance” along with the items “one-leg stance,” “rise to toes,” “compensatory stepping backward,” “turning 360°,” and “placing foot on stool” when analyzing postural control deficits related to fall risk. Future research should analyze whether balance training including the aforementioned items is effective in reducing fall risk.