Falls and fall-related injuries in patients with PSP
Lead researcher Professor Bastian R. Bloem
Co-researchers Professor Andrew Lees & Professor Niall Quinn, Dr Anette Schrag
Institution Institute of Neurology, Queen Square, London
Duration 1 year
Start August 2000 End July 2001
Aim of research
To determine the frequency, characteristics and determinants of falls and their associated injuries in Progressive Supranuclear Palsy.
About the research
The development of postural instability and recurrent falls early in the course of the disease is an important feature of PSP. However, detailed information on falls and their consequences (injuries, fear) is lacking.
A comprehensive questionnaire on prior falls was sent to 200 members of The PSP Association in the UK. Useful answers were obtained from 117 patients (median age 70 years; disease duration 5 years). Two control groups included 140 consecutive outpatients with Parkinson's disease (PD; median age 64 years; disease duration 10 years) and 82 healthy controls (median age 59 years). Falls were also monitored prospectively for three months, using standard diaries and telephone reminders.
Findings
Among PSP patients, 33 could only walk with assistance, and 19 could not stand at all. At least one fall had occurred since disease onset in 97% of PSP patients and in 65% of PD patients (p<0.001). The very first fall (mean, SD) occurred after 4.1 (1.9) years for PSP patients and after 9.0 (6.8) years for PD patients (p<0.005). Daily falls were present in 23% of PSP patients who were still mobile, compared to only 6% of PD patients. Falls were predominantly backward in 45% of PSP patients. Conversely, most PD patients (45%) fell forward. Blepharospasm contributed to falls in 24% of PSP patients, compared to only 4% of PD patients (p<0.001). Injuries had occurred in 90% of PSP patients versus 42% of PD patients (p<0.001). Fractures, mainly of the arms and hips, had occurred in 46% of PSP patients but in only 4% of PD patients. Head injuries and soft tissue injuries were also more common in PSP. Fear of falls was present in 89% of PSP patients versus 59% of PD patients (p<0.001). Balance confidence, on a scale of 0-100, with 0 being worst performance, was 17.6 (22.6) for PSP patients versus 67.8 (23.0) for PD patients (p<0.001). Only walking aids and support by the partner or other carer helped to reduce falls. Medication was rarely considered helpful.
Falls, particularly in a backward direction, are very common in PSP. Blepharospasm was a common cause of falls. Devastating consequences (immobility, fractures and fear) are frequent and more common in PSP than in PD. The high injury rate might be associated with motor recklessness. These results offer possible opportunities for preventive strategies.
What does the outcome of this research mean for people with PSP?
This research has provided sound evidence that in PSP falls are frequent and can have enormous impact on the lives of patients and their families. Informing patients and their carers and families, and health and social care professionals about the potential for falls in PSP, should help ensure that strategies are adopted to help reduce the risk of falls and avoid injury. A better understanding of the determinants of falls in PSP will help in the development of improved treatment and preventative strategies.
Publications arising from the work
B. R. Bloem, M. Munneke, G. Mazibrada, A. Schrag, R. Viswanathan, A. J. Lees, N. P. Quinn. The nature of falling in progressive supranuclear palsy. Mov Disord 19:359-360, 2004.
National/international presentations given on this work
The results of this work have been discussed at various national and international conferences, including several lectures at The PSP Association's Annual Symposium for Carers and Therapists.
Weblink www.parkinsonweb.nl
How has the research you conducted influenced your career and research direction?
Professor Bloem says,
"The support I received from The PSP Association has helped establish my international reputation as a movement disorders expert and researcher in the field of gait and balance disorders.
Of PSP Professor Bloem says,
"Falls cause so much avoidable suffering in patients with PSP. There is a great need for research to establish the merits of currently available and new therapeutic interventions to reduce falls and avoid injuries in patients with PSP".