A novel approach to falls classification in Parkinson’s disease: Development of the Fall-Related Activity Classification (FRAC)

Does your therapist have a fall classification system for stroke? If not, how the hell can s/he use the correct fall prevention protocol on you? This is so fucking simple, you objectively get your fall risks classified and then use the correct protocols to work on prevention.
1. Have dropfoot - Use dropfoot protocol 1,2, or 3 depending on how well you can dorsiflex.
2. Ankle rolls - Use ankle rolling protocol 1 or 2 depending on whether it rolls inward or outward.
3. Has pusher syndrome - Use pusher protocol 1 or 2 depending on whether you have ability to resist.
4. Bad foot catches on good ankle on follow through - Use inner catch protocol 1 or 2.
5. Falls over while standing still - Use ankle sway protocol or hip sway protocol.
6. Falls in transitioning from sitting to standing- Use sit to stand protocol.
7. Falls in transitioning from standing to sitting - Use stand to sit protocol.
8. etc., etc. etc.
Of course none of these protocols exist  but they all should if we had any therapist leaders at all driving survivor rehabilitation. Whatever was learned in college is not enough to get survivors rehabbed. As proven by the absolutely pathetic full recovery rate of 10%.
But Parkinsons is here, read it and weep.
http://www.physiotherapyjournal.com/article/S0031-9406%2816%2930057-8/fulltext?rss=yes

Annie RossPress enter key to Email the author

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Alison J. YarnallPress enter key to Email the author

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Lynn RochesterPress enter key to Email the author

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Sue LordPress enter key for correspondence informationPress enter key to Email the author

Institute of Neuroscience, Newcastle University Institute for Aging, Newcastle upon Tyne, UK

DOI: http://dx.doi.org/10.1016/j.physio.2016.08.002

• Abstract

Abstract

Background

Falls are a major problem for people with Parkinson's disease (PD). Despite years of focused research knowledge of falls aetiology is poor. This may be partly due to classification approaches which conventionally report fall frequency. This nosology is blunt, and does not take into account causality or the circumstances in which the fall occurred. For example, it is likely that people who fall from a postural transition are phenotypically different to those who fall during high level activities. Recent evidence supports the use of a novel falls classification based on fall related activity, however its clinimetric properties have not yet been tested.

Objective

This study describes further development of the Fall-Related Activity Classification (FRAC) and reports on its inter-rater reliability (IRR).

Method

Descriptors of the FRAC were refined through an iterative process with a multidisciplinary team. Three categories based on the activity preceding the fall were identified. PD fallers were categorised as: 1) advanced 2) combined or 3) transitional. Fifty-five fall scenarios were rated by 23 raters using a standardised process. Raters comprised 3 clinical subgroups: 1) physiotherapists, 2) physicians, 3) non-medical researchers. IRR analysis was performed using weighted kappa coefficients and included sub group analysis based on clinical speciality.

Results

Excellent agreement was reached for all clinicians, κ = 0.807 (95%CI 0.732-0.870). Clinical subgroups performed similarly well (range of κ = 0.780 - 0.822).

Conclusion

The FRAC can be reliably used to classify falls. This may discriminate between phenotypically different fallers and subsequently strengthen falls predictors in future studies.

Keywords:

falls, classification, reliability

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