Introduction. We analyzed the ability of four balance assessments to predict falls in people with Parkinson Disease (PD) prospectively over six and 12 months. Materials and Methods. The BESTest, Mini-BESTest, Functional Gait Assessment (FGA), and Berg Balance Scale (BBS) were administered to 80 participants with idiopathic PD at baseline. Falls were then tracked for 12 months. Ability of each test to predict falls at six and 12 months was assessed using ROC curves and likelihood ratios (LR). Results. Twenty-seven percent of the sample had fallen at six months, and 32% of the sample had fallen at 12 months. At six months, areas under the ROC curve (AUC) for the tests ranged from 0.8 (FGA) to 0.89 (BESTest) with LR+ of 3.4 (FGA) to 5.8 (BESTest). At 12 months, AUCs ranged from 0.68 (BESTest, BBS) to 0.77 (Mini-BESTest) with LR+ of 1.8 (BESTest) to 2.4 (BBS, FGA). Discussion. The various balance tests were effective in predicting falls at six months. All tests were relatively ineffective at 12 months. Conclusion. This pilot study suggests that people with PD should be assessed biannually for fall risk. 1. Introduction Postural instability is a common cause of falls in people with Parkinson disease (PD) [1]. In contrast to community-dwelling adults over age 65, approximately one-third of whom report falling each year [2], up to 70% of individuals with PD fall once annually, while 50% fall twice or more in a one year period [3, 4]. Falls lead to a myriad of complications [5] that can affect not only physical health, but also the psychological health of the individual. Hip fracture and head trauma are two of the most common physical problems incurred by an individual with PD following a fall [6], while the psychological complications include fear of falling [7, 8] and reduced quality of life [9]. Such fall-related complications are associated with substantial economic costs [10, 11] and indicate an urgent need to identify and protect those individuals at the greatest risk. Despite the relatively high prevalence of falls in the PD population, accurate and useful methods for predicting an impending future fall, especially during the early stages of the disease, remain elusive. Fall history, a well-known fall risk factor among older adults [12], has a limited utility as a solitary predictive indicator. Although a meta-analysis of prospective studies of falling in PD found that 57% of individuals who had a history of falls in the past year fell during a 3-month surveillance period, so did 21% of individuals with no history of falls [13]. Moreover, fall incidence
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