Development and Validation of a Fall Questionnaire for Patients with Parkinson's Disease

BACKGROUND: In Parkinson's disease, postural instability and falls are of particular socioeconomic relevance. Although effective fall prevention and the prophylaxis of fall‐related injuries depend on low‐threshold symptom monitoring, validated instruments are lacking. OBJECTIVES: To develop a self‐report questionnaire for the assessment of falls, near falls, fear of falling, fall‐related injuries, and causes of falls for patients with Parkinson's disease (PwPD). METHODS: A pool of potential items was generated from a literature review and by discussion in an expert panel. The first version of the Dresden Fall Questionnaire (DREFAQ) was tested in a group of German‐speaking movement disorder specialists as well as PwPD. The resulting 5‐item questionnaire was assessed in a validation cohort of 36 PwPD who documented fall events and near‐fall events in a calendar for 3 months and completed the DREFAQ at the end of the study. The questionnaire was subsequently used in a separate cohort of 46 PwPD to determine test–retest reliability and confirm the factor structure. RESULTS: The DREFAQ showed good internal consistency (Cronbach's α = 0.84) and good test–retest reliability (intraclass correlation coefficient, 0.76; 95% confidence interval, 0.60–0.86). The total DREFAQ score showed good concurrent validity with fall events (Spearman's ρ = 0.82) and near‐fall events (Spearman's ρ = 0.78) as determined by fall and near‐fall diaries. Factor analysis revealed a 2‐factor structure composed of near falls with fear of falling and severe falls with injuries. CONCLUSIONS: The DREFAQ is a reliable and valid 5‐item questionnaire for determining the incidence of falls, near falls, fear of falling, fall‐related injuries, and causes of falls in PwPD.