Prospective Predictive Accuracy Versus Previous-Fall Discriminative Validity of Clinical Assessment Tools for Fall Risk in Parkinson’s Disease: A Systematic Review and Meta-Analysis
4 affiliations
- 1Department of Physical Therapy, Faculty of Medicine, CEIR Campus Mare Nostrum (CMN), University of Murcia, 30120 Murcia, Region of Murcia, Spain
- 2Biomedical Research Institute of Murcia Pascual Parrilla-IMIB, 30120 Murcia, Region of Murcia, Spain
- 3Department of Basic Psychology and Methodology, Faculty of Psychology, University of Murcia, Campus de Espinardo, 30100 Murcia, Region of Murcia, Spain
- 4Association of Relatives of People with Neurodegenerative Diseases and Prevention of Pathological Ageing (AFA Levante), 30205 Cartagena, Region of Murcia, Spain
Abstract
Background/Objectives: Many clinical tools are used to assess fall risk in Parkinson’s disease (PD). We examined whether tools that discriminate people with a history of falls also predict future falls. Methods: Six electronic databases were searched through January 2025, and the search was later updated. Hedges’ g and the area under the receiver operating characteristic curve (AUC) were pooled separately for previous-fall and prospective designs using three-level models with cluster-robust variance estimation and one estimate per cohort per clinical domain or instrument. Results: Forty-five reports were included; 42 reports from 36 independent cohorts contributed to the meta-analyses. Fallers performed worse than non-fallers in previous-fall (g = −0.82; 95% confidence interval [CI] −1.03 to −0.62; 20 cohorts) and prospective designs (g = −0.61; 95% CI −0.75 to −0.48; 14 cohorts), most markedly on balance and fall-confidence measures. The pooled AUC was 0.80 (95% CI 0.74–0.85) for previous falls and 0.70 (95% CI 0.63–0.76) for future falls, and prospective accuracy remained lower within the balance domain. Prospective AUCs of individual domains and instruments ranged from 0.60 to 0.78, and the certainty of evidence was low to moderate. Conclusions: Discrimination of fall history overstates prospective predictive accuracy. Clinical tools characterize fall-related impairments but should not be used as stand-alone predictors of future falls in PD.
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BibTeX
@article{meseguerhenarejos2026prospective,
title = {{Prospective Predictive Accuracy Versus Previous-Fall Discriminative Validity of Clinical Assessment Tools for Fall Risk in Parkinson’s Disease: A Systematic Review and Meta-Analysis}},
author = {Ana-Belén Meseguer-Henarejos and Juan-José López-García and José-Antonio López-Pina and Raúl Nieto-Galera and Ángel Martínez-Carrasco},
journal = {Journal of Clinical Medicine},
year = {2026},
month = nov,
doi = {10.3390/jcm15228776},
url = {https://www.mdpi.com/2077-0383/15/22/8776},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Prospective Predictive Accuracy Versus Previous-Fall Discriminative Validity of Clinical Assessment Tools for Fall Risk in Parkinson’s Disease: A Systematic Review and Meta-Analysis
AU - Ana-Belén Meseguer-Henarejos
AU - Juan-José López-García
AU - José-Antonio López-Pina
AU - Raúl Nieto-Galera
AU - Ángel Martínez-Carrasco
PY - 2026
DA - 2026/11/10
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15228776
UR - https://www.mdpi.com/2077-0383/15/22/8776
AB - Background/Objectives: Many clinical tools are used to assess fall risk in Parkinson’s disease (PD). We examined whether tools that discriminate people with a history of falls also predict future falls. Methods: Six electronic databases were searched through January 2025, and the search was later updated. Hedges’ g and the area under the receiver operating characteristic curve (AUC) were pooled separately for previous-fall and prospective designs using three-level models with cluster-robust variance estimation and one estimate per cohort per clinical domain or instrument. Results: Forty-five reports were included; 42 reports from 36 independent cohorts contributed to the meta-analyses. Fallers performed worse than non-fallers in previous-fall (g = −0.82; 95% confidence interval [CI] −1.03 to −0.62; 20 cohorts) and prospective designs (g = −0.61; 95% CI −0.75 to −0.48; 14 cohorts), most markedly on balance and fall-confidence measures. The pooled AUC was 0.80 (95% CI 0.74–0.85) for previous falls and 0.70 (95% CI 0.63–0.76) for future falls, and prospective accuracy remained lower within the balance domain. Prospective AUCs of individual domains and instruments ranged from 0.60 to 0.78, and the certainty of evidence was low to moderate. Conclusions: Discrimination of fall history overstates prospective predictive accuracy. Clinical tools characterize fall-related impairments but should not be used as stand-alone predictors of future falls in PD.
SN - 2077-0383
ER -