Clinical tests for the evaluation of postural instability in patients with parkinson's disease

Arch Phys Med Rehabil. 2003 Nov;84(11):1669-74. doi: 10.1053/s0003-9993(03)00348-4.


Objective: To determine which test for postural instability in Parkinson's disease (PD) is reliable, valid, and easy to perform in a clinical setting.

Design: Cross-sectional reliability and validity study.

Setting: Academic center for movement disorders.

Participants: Forty-two patients with PD and 15 controls. Based on the results of a structured interview, the patients were divided in PD-unstable (n=22) and PD-stable (n=20) groups.

Interventions: Not applicable.

Main outcome measures: Several variants of the retropulsion test with differences in execution and scoring. Responses were scored on 5 different rating scales (ratings of Nutt, Bloem, Pastor; the Unified Parkinson's Disease Rating Scale [UPDRS]; the Short Parkinson Evaluation Scale). These tests were compared with steady-stance positions.

Results: The interrater reliability was high for most ratings, with weighted kappa ranging from.63 for the UPDRS to.98 for both the Pastor rating and steady-stance positions. Most ratings distinguished between the groups. However, the Nutt rating had the highest overall predictive accuracy, with a sensitivity of.63 and a specificity of.88.

Conclusions: The most valid test for postural stability in PD was an unexpected shoulder pull, executed once, with taking more than 2 steps backward considered abnormal. This retropulsion test is easy to use in a clinical setting.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Accidental Falls / statistics & numerical data
  • Aged
  • Case-Control Studies
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Parkinson Disease / classification*
  • Parkinson Disease / physiopathology
  • Parkinson Disease / rehabilitation
  • Postural Balance*
  • Posture*
  • Reproducibility of Results