Identifying Predictors of Discordance Between Balance Perception and Ability in Parkinson Disease

BACKGROUND AND PURPOSE: Balance discordance, or malalignment between balance ability and confidence, has been linked to retrospective falls in Parkinson disease. This study aimed to identify modifiable factors related to balance discordance to determine potential targets for fall prevention interventions. METHODS: This cross-sectional secondary analysis included 188 individuals with Parkinson disease. Balance discordance was derived from balance ability (Timed Up and Go) and balance confidence (Activities Balance Confidence Scale). Demographic factors (age, sex), disease severity (disease duration, Hoehn and Yahr Scale), balance ability (Mini-BESTest), daily physical activity via actigraphy, perceived health (EuroQol-5D Visual Analog Scale [EQ5D-VAS]), cognitive ability (Trail Making Test B, Montreal Cognitive Assessment), anxiety and depression (Hospital Anxiety and Depression Scale) were examined in relation to balance discordance. Pearson correlations explored bivariate relationships, and ridge regression with cross-validation identified unique contributors. RESULTS: Discordance was significantly related to EQ5D-VAS (r = 0.46), depression (r = -0.47), and anxiety (r = -0.37). The final model (EQ5D-VAS, sex, disease duration) accounted for 29.08% of variance, with EQ5D-VAS (β = 0.513, P < 0.001) as a significant predictor. DISCUSSION AND CONCLUSIONS: Perceived health was strongly related to discordance, suggesting shared perceptual factors may drive discordance and fall risk. Anxiety and depression were also related to discordance. Addressing these factors may facilitate improved alignment between balance ability and confidence, reduce fall risk, and improve physical engagement and quality of life.