Dynamic balance measurements can differentiate fallers from non-fallers in patients with idiopathic normal pressure hydrocephalus

Publication date: Available online 4 February 2019

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Yasutaka Nikaido, Yoshinaga Kajimoto, Toshihiro Akisue, Hideyuki Urakami, Yuki Kawami, Kenji Kuroda, Hiroshi Ohno, Ryuichi Saura

Abstract

Objectives

To investigate which clinical assessments are suitable for differentiating fallers from non-fallers in patients with idiopathic normal pressure hydrocephalus (iNPH).

Design

Prospective observational study.

Setting

Medical College Hospital.

Participants

Sixty-eight patients with a cerebrospinal fluid tap test (TT) result meeting the diagnosis criteria for iNPH.

Interventions

Not applicable.

Main Outcome Measures

Participants were assessed before the TT based on the following: Timed Up & Go (TUG), 10-meter walk test (10MWT), Functional Gait Assessment (FGA), Berg Balance Scale (BBS), isometric quadriceps strength (QS), and a history of falls within the past 6 months.

Results

The full area under the curve of the receiver operating characteristic curves (AUC [95% CI]) was found to be 0.651 (0.503–0.775) for the TUG, 0.692 (0.540–0.812) for the 10MWT, 0.869 (0.761–0.933) for the FGA, and 0.796 (0.663–0.886) for the BBS; except for QS, they all were identified as statistically significant predictive variables. In the TUG <20 s group (n=47), the FGA (AUC; 0.849, [0.698–0.932]) and BBS (AUC; 0.734, [0.550–0.862]) were found to be statistically significant predictive variables; however, the other assessments were not. In the TUG <15 s group (n=34), the FGA was found to be the only statistically significant predictive variable (AUC; 0.842, [0.640–0.942]), whereas the other assessments were not. The AUC of the FGA was statistically significantly greater than those of the other assessments.

Conclusions

Our findings indicate that the falls patients experience with iNPH may be associated with dynamic balance dysfunction during gait rather than lower limb muscle strength. The FGA may be more suitable than other assessments for differentiating fallers from non-fallers in patients with mild iNPH.

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