Citation

Wiles CM, Busse ME, Sampson CM, Rogers MT, Fenton-May J, van Deursen R. J. Neurol. Neurosurg. Psychiatry 2005; 77(3): 393-396.

Affiliation

Cardiff University, United Kingdom.

Copyright

(Copyright © 2005, BMJ Publishing Group)

DOI

10.1136/jnnp.2005.066258

PMID

16199443

PMCID

PMC2077718

Abstract

BACKGROUND: Falls and consequential injury are common in the elderly but their frequency and risk factors are unclear in patients with neuromuscular diseases. Patients with myotonic dystrophy type 1 (DM1) seem prone to have troublesome falls. We therefore investigated falls and risk factors in this patient group and healthy volunteers. METHODS: 13 patients with DM1 from different kindreds were recruited sequentially and compared with 12 healthy volunteers. A questionnaire about falls and the clinic case notes were reviewed. Prospectively, all subjects were evaluated using the Rivermead Mobility Index, the Performance Oriented Mobility Assessment and the modified Activities Specific Balance Confidence scale. All had measures of lower limb muscle strength, gait speed, and 7 day ambulatory activity monitoring recorded. Over 13 weeks subjects returned a weekly card indicating any stumbles or falls which were then classified following a personal telephone debriefing: a final card was returned at 26 weeks. RESULTS: 11/13 patients (mean age 46.5 yrs, 7 female) had 127 stumbles and 34 falls over the 13 weeks compared to 10/12 healthy subjects (34.4 years, 7 female) who had 26 stumbles and 3 falls. Patients were less active than healthy subjects but nevertheless had more falls and stumbles per 5000 right steps taken (mean (sd) events 0.21 (0.29) versus 0.02 (0.02) p=0.007). Patients who fell (n=6) had on average a lower Rivermead Mobility score, slower self selected gait speed and higher depression scores than those (n=7) who did not. CONCLUSIONS: DM1 patients stumble or fall about ten times more often in relation their ambulatory activity than healthy volunteers. Routine enquiry about falls and stumbles therefore seems justified. A study of multidisciplinary evaluation and intervention to try and reduce the risk of stumbles and falls would appear warranted.