Propriedades de medida dos instrumentos de avaliação do equilíbrio e risco de quedas na doença de Parkinson: uma revisão sistemática

Abstract

Background: Postural instability has been implicated as a risk factor for the occurrence of falls in people with Parkinsons disease (PD), being more frequent in the late stages of the disease, leading to impaired balance and frequent falls. The consequences of the postural instability can have devastating effects such as pain, activity limitations, fear of falling, depression and fractures. Evidence has shown that individuals with PD can benefit from physical therapy interventions, such as gait training and specific tasks of postural control training. The measure of balance is a key component of physical therapy evaluation in patients with PD, because it allows the professional to identify and quantify the deficits of balance and risk of falls and monitor the progression of the same and thus conduct a appropriate clinical decision making. Appropriate measurement instruments are essential to obtain objective and quantitative data about what it intends to measure, allowing comparisons between different populations. The quality of a measurement instrument is directly related to its measurement properties such as reliability, validity and responsiveness. Objectives: To identify the most utilized clinical assessment instruments of balance and risk of falls for PD, to characterize the measurement properties of the instruments, and to determine the methodological quality of the studies analysed. Materials and methods: This study is a systematic review of methodological studies of measurement properties of clinical assessment instruments of balance and risk of falls. The databases MEDLINE, LILACS, CINAHL and SPORTDiscus were searched until March 2013. Methodological studies which developed the clinical assessment instruments of balance and risk of falls in PD as well as those which rated their measurement properties were included. The assessment of methodological quality was performed by two independent raters using the Checklist COSMIN (Consensus -based Standards for the Selection of Health Measurement Instruments). The estimates were summarized for each instrument and the measurement properties were rated according to the levels of evidence strong, moderate, limited, conflicting and unknown Results: The initial search strategy identified 150 studies, of which 20 were included in the systematic review. Fourteen instruments were found. Moderate evidence was presented for an adequate internal consistency of the Berg Balance Scale (BBS), adequate test-retest reliability of Survey of Activities and Fear of Falling in the Elderly (SAFFE NL) and Swedish Falls Eficacy Scale (FES-S) and adequate criterion validity of the Balance Evaluation Systems Test (BESTEST) and Functional Gait Assessment (FGA). Conclusion: The methodological quality of studies and level of evidence analysis highlighted five potentially most appropriate instruments at present to measure the balance or the risk of falls in PD. They are: BBS, BESTEST, FGA in the category of performance instruments and SAFFE and FES-S in the category of self-report questionnaires.