Within-subject variation in the cognitive timed up and go test as an explanatory variable in fall risk in patients with parkinson's disease.
Sergio Sebastia-Amat, Juan Tortosa-Martínez, Miguel García-Jaén and 1 others
PMID 34553234WHAT IT FOUND
In Parkinson's disease, greater within-session variation in the cognitive Timed Up and Go test time strongly predicts recurrent falls.
A cut-off of 1.53 seconds identified recurrent fallers with acceptable accuracy. Single-trial testing may miss this risk signal.
Key findings
01Within-session variation in the cognitive Timed Up and Go test was the strongest independent predictor of fall history, with an odds ratio of 2.47 per 1-second increase.
02The cognitive Timed Up and Go within-session variation showed acceptable accuracy for discriminating recurrent fallers, with an area under the curve of 0.757 and a cut-off point of 1.53 seconds.
03Body mass index, fear of falling, and closed-eyes centre-of-pressure velocity were also significant explanatory variables for fall risk in the multivariate model.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
Small sample size (53 participants) limits generalisability. Most participants had mild to moderate disease (Hoehn and Yahr 1-4), so findings may not apply to advanced Parkinson's disease. Fall history was assessed retrospectively by self-report rather than prospective monitoring. Cognitive function was screened with the MMSE rather than the MoCA, which is more sensitive to executive deficits relevant to dual-task performance. A small learning effect between trials could have influenced within-session variation.
Declared interests
The authors declare no conflicts of interest.
The easy way to misread this
Do not assume that a single cognitive Timed Up and Go trial captures this risk. The finding rests on within-session variation across three trials, and the paper does not show that a single-trial time discriminates fallers as well. The study is cross-sectional with retrospective fall history, so it identifies an association rather than proving that variation causes falls.