Medical Journal of The Islamic Republic of Iran (MJIRI)

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Background: Despite the negative effect of fear of falling during functioning and social participation of patients with Parkinson' disease, so far, only few studies have investigated its effect on the quality of life in these patients. We aimed to investigate the association between fear of falling and quality of life controlling for balance impairments based on hip and ankle strategy in drug On- and Off-phase of patients with idiopathic Parkinson' disease.

  Methods: In this non-experimental cross-sectional study, 139 patients with idiopathic Parkinson' disease (100 male, 39 female) by mean± SD age of 60.2±12.27 years, mean±SD time since diagnosis of 6.7±5.53 years and mean±SD Hoehn and Yahr stage of 2.8±1.49 were selected by a simple non-probability method. Balance function was measured by a functional reach test with hip and ankle strategy. The Persian version of the self-completed Fall Efficacy Scale-International and Parkinson's disease quality of life questionnaire was used to evaluate fear of falling and quality of life, respectively.

  Results: The results showed that the score of all dimensions of quality of life (i.e., mobility, activities of daily living, emotional wellbeing, stigma, social support, cognition, communication and bodily discomfort) were significantly affected by the intensity of fear of falling. Multiple regression analysis indicated a significant association between fear of falling and quality of life in a way that fear of falling explained 11% to 47% and 12% to 43% of variance in drug On-phase, as well as 8% to 45% and 9% to 48% of variance in the drug Off-phase in dimensions of quality of life after controlling for balance function based on hip and ankle strategy, respectively. In the drug On-phase, the strongest association (R=0.85, p<0.001) was found between fear of falling and mobility dimension of quality of life. In the drug Off-phase, the strongest relation was observed between fear of falling and mobility (R=0.82, p<0.001) as well as activities of daily living (R=0.78-0.79, p<0.001) dimensions.

  Conclusion: This study found that fear of falling affects the quality of life of patients with Parkinson' disease beyond its relationship with balance impairments based on the hip and ankle strategy in both drug On- and Off-phase. 

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Background: Katz Index is a well-known index for assessing basic activities of daily living. The aim was to determine validity and reliability of the Katz Index in Iranian patients with acute stroke.

Methods: Eighty-seven patients (56 male, 31 female) with acute stroke (1-30 days post-stroke) participated in this psychometric properties study. Interval time for retest was 14 days. All participants were Iranian with Persian as native language, had no other major diseases (e.g. cancer, Alzheimer) and no psychiatric disorder. Cognitive mental score of all participants was above 18 (according to Mini-Mental State Examination). If they had another stroke during the following-up period, they were excluded from the study. Intraclass Correlation Coefficient (ICC), Standard Error of Measurement (SEM) and Minimum Detectable Change (MDC) were calculated to investigate the reliability of the KI. Criterion validity of the KI was assessed by Spearman’s Correlation Coefficient (ρ). Moreover, Confirmatory Factor Analysis (CFA) and Exploratory Factor Analysis (EFA) were performed to investigate the construct validity of the KI.

Results: Inter-rater and intra-rater reliability of Persian Katz Index were reasonable (ICC_2,1=0.93, ICC_2,1=0.83; respectively). Internal consistency of this index was high (cronbach’s alpha=0.79). The high to excellent correlation was found between Katz Index and the motion (ρ=0.88), self-care (ρ=0.98), and total scores (ρ=0.92) of Barthel Index. Factor analysis of the Persian Katz Index indicated two factors including motion (bathing, toileting, and transferring) and self-care (dressing, bowel & bladder control, and feeding).

Conclusion: The results of this study suggest that Persian version of Katz Index in patients with acute stroke can be considered as an acceptable clinical instrument in practice and research.

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    The ICF (the international classification of functioning, disability, and health) is a globally agreed framework and classification to define the spectrum of problems in the functioning of patients. ICF tools were developed based on ICF Core Set (ICF-CS) for the clinical application of ICF and patient management in the rehabilitation process. The current case report aimed at using ICF-based documentation tools in the occupational therapy process in a patient with chronic stroke. The case was a male who had a stroke 6 months prior to the study. The occupational therapy provided to this patient included 5 patient management components (examination, evaluation, prognosis, diagnosis, and intervention) using the ICF-based documentation tool. After one month, improvement in balance and mobility, going up and down the stairs without help, independent upper and lower body dressing achieved.  The ICF was clinically applied to the occupational therapy practice in this case report. Because of the close relationship of ICF tools with the concept of occupational therapy, particularly client-centered approach and holistic evaluation of patients, occupational therapists can use ICF in clinical practice to have a more comprehensive view toward patients’ recovery.