Award Date

Spring 5-2014

Degree Type


Degree Name

Doctor of Physical Therapy (DPT)


Physical Therapy

Advisor 1

Merrill Landers

First Committee Member

Merrill Landers

Second Committee Member

Kai-Yu Ho

Number of Pages



Background and Purpose: The purpose of this study was to compare individuals with Parkinson’s disease (PD) exhibiting fear of falling avoidance behavior to those with no fear of falling avoidance behavior. Because avoidance behavior can have deleterious downstream consequences, it is important to determine what potentially mitigated physical and psychological factors are associated with it.

Subjects: Fifty-six community dwelling individuals (age=72.1 years, SD=9.6; males=42, females=14) with PD (Hoehn and Yahr Scale stage median=2.0, mode=3.0) were classified into two groups using the Fear of Falls Avoidance Behavior Questionnaire (FFABQ): avoiders (n=26, ≥20 FFABQ), and non-avoiders (n=30, <20 on the FFABQ).

Methods: Avoiders and non-avoiders were compared using five domains: demographics (age, gender, socioeconomic status (SES), education), PD (Parkinson’s Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), Hoehn and Yahr Scale, Parkinson’s Disease Questionnaire (PDQ-39)), balance and falls (fall history, Berg Balance Scale (BBS), Activities Specific Balance Scale (ABC)), physical performance (2-minute step test (2MST), 30 second Sit to Stand Test (30STS), Timed Up and Go Test (TUGT), ActivPAL physical activity monitor data), and psychological factors (Zung Anxiety Scale (ZAS), Beck Depression Inventory (BDI)).

Results: There were no differences between avoiders and non-avoiders in age, gender, SES, education, year of diagnosis, and fall history, including injurious falls (ps>0.272). Avoiders had worse scores on the MDS-UPDRS (sections I-III, ps<0.014) and the PDQ (mobility, ADLs, emotion, stigma, cognition, and bodily discomfort subscales, ps<0.028). Avoiders also exhibited poorer balance performance and less balance iv confidence (BBS, p=0.003; ABC, p<0.001; FES, p=0.048). Avoiders reported higher depression, anxiety, and catastrophization (BDI, p=0.015; ZAS, p=0.028; CAFS, p=0.001; CoFQ, p<0.001).

Discussion: Results of this study suggest that individuals with PD who report higher avoidance behaviors have more involved PD symptoms, score lower for balance, strength and conditioning, and have greater psychological distress, including depression, anxiety, and catastrophization. There were no differences in fall history between the two groups, presumably because avoiders may have avoided activities that increase the risk for a potential fall. While these findings suggest that avoidance behavior has both physical and psychological dimensions, the cause-effect relationship cannot be determined.


Behavior and Behavior Mechanisms; Physical Therapy


Physical Therapy

File Format


File Size

694 Kb

Degree Grantor

University of Nevada, Las Vegas




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