Appendix A. Fear Of Falling Avoidance Behavior Questionnaire

Appendix A. Fear of Falling Avoidance Behavior QuestionnairePlease answer the following questions that are related to your balance. For each statement, please check one box tosay how the fear of falling has or has not affected you. If you do not currently do the activities in question, try andimagine how your fear of falling would affect your participation in these activities. If you normally use a walking aid todo these activities or hold onto someone, rate how your fear of falling would affect you as if you were not using thesesupports. If you have questions about answering any of these statements, please ask the questionnaire administrator.Please check one box for each questionDue to my fear of falling, I avoid 1.Walking2.Lifting and carrying objects(e.g., cup, child)3.Going up and downstairs4.Walking on different surfaces(e.g., grass, uneven ground)5.Walking in crowded places6.Walking in dimly lit, unfamiliar places7.Leaving home8.Getting in and out of a chair9.Showering and/or bathing10.Exercise11.Preparing meals(e.g., planning, cooking, serving)12.Doing housework(e.g., cleaning, washing clothes)13.Work and/or volunteer l and leisure activities(e.g., play, sports, arts and culture,crafts, hobbies, socializing, travelling)Please make sure you have checked one box for each question. Thank you!TOTAL:AgreeCompletelyagree

Appendix B. Parkinson’s disease domain variables.ScalePD subtype23MDS-UPDRS27Hoehn andYahr Scale28PDQ-3931,32ConstructA ratio of scores from the MDS-UPDRS is usedto define tremor dominant (TD) and posturalinstability/gait difficulty (PIGD) phenotypes ofPD. The mean for all 11 MDS-UPDRS fortremor were divided by the mean for the 5PIGD items. If the resultant ratio was 1.15then the person was classified as TD and if theratio was 0.90 then the person was classifiedas PIGD phenotype. A score in between thesevalues was classified as indeterminate.65 item clinical rating scale for PD includinginterview, clinician rating and self-assessmentof PD severity that has 4 parts: I. Non motorexperiences of daily living; II. Motorexperiences of daily living; III. Motorexamination; IV. Motor complications0 to 5 staging scale that provides a generalestimate of disease severity in PD with 0indicating that the individual is asymptomaticand 5 indicating severely impaired posturalstability and functional mobility.Self-report measure of PD related QOL with39 items in 8 subsections (mobility, activitiesof daily living, emotional well-being, stigma,social support, cognition, communication,bodily discomfort). Each item ranges from 0(never) to 4 (always). The overall score andsubsection scores are calculated by taking themeans of each item divided by the total forthat section; thus, converting the score into apercentage with higher percentages equatingto more disability.Evidence forreliabilityEvidence forvalidity in PDReliability has not beendetermined for this newscale.TD and PIGD phenotypeshave been linked todifferent clinical featuresand progressions.24-26High internal consistency(Cronbach’s α 0.79 – 0.93across parts)27Found to be highlycorrelated with theoriginal UPDRS (r .96).27Good reliably for moderatestages (2-4)28Correlations with β-CITSPECT scanning29 andfluorodopa PETscanning30 suggestingconvergent validityCronbach’s α 0.72 – 0.95;test-retest reliability .76 –0.9333Correlations found withBDI 17, MMSE 25,history of falls, posturalinstability and gaitimpairments (p 0.001)34

Appendix C. Balance and fall domain variables.ScaleConstructEvidence forreliabilityEvidence forvalidityBerg BalanceScale (BBS)35Clinician-rated assessment of balancewith 14 different balance tasks. Scoresrange from 0 to 56 with higher scoressuggesting better balance performance.Excellent test-retestreliability (ICC 0.94)36 andinterrater reliability (ICC 0.93 in PD37Area under the ROC curve(0.851) for predicting fallstatus in those with PD38Excellent test-retestreliability in PD (ICC 0.96)40High ABC score isassociated with decreasedfall risk in PD41High internal consistency(Cronbach’s .86 forintrusion, and Cronbach’s .82 for avoidance)44Can discriminate betweenstress reactions atdifferent times after anevent and highlycorrelates with posttraumatic stress disorderdiagnosis44Excellent internal reliability(Cronbach’s α .86 – .94)and moderate test-retestreliability (ICC .61 - .64)45CoFQ is correlated withavoidance of activity andpredicted avoidance inactivity 6 months later45Activities-SpecificBalanceConfidence Scale(ABC)39Impact of EventsScale (IES)42,43Consequences ofFallingQuestionnaire(CoFQ)45Subjective rating of balance confidencewith 16 different ambulatory activities.Items are rated on a rating scale of 0 to100 with higher scores representingmore confidence. The ABC score is theaverage subjective rating of all 16items.15 item self-report measure to assessdistress levels related to a traumatic lifeevent. The total score is the overallstress from the event (fall/falls). Thereare three subscales: intrusion (e.g.,intrusive thoughts, nightmares,intrusive feelings and imagery,dissociative-like re-experiencing),avoidance (e.g., numbing ofresponsiveness, avoidance of feelings,situations, and ideas), and hyperarousal(e.g., anger, irritability, hypervigilance,difficulty concentrating, heightenedstartle).Self-report questionnaire about the lossof functional independence (6 items)and damage to identity (6 items) thatmay occur because of a fall. All itemsare based on a Likert scale (disagreestrongly, disagree, agree, and agreestrongly) with responses assignedpoints of 1 through 4, respectively.Scores range from 12 to 48 with higherscores equating to morecatastrophizing thoughts about falls.

Appendix D. Physical performance and psychological domain variables.Evidence forScaleConstructreliability30 second Sit-toStand Test(30STS)46,47Assessment of one’s ability to performrepeated sit to stands from a chair for30 seconds as a measure of functionallower extremity strength.Excellent test-retestreliability (ICCs 0.84)46,48Timed Up and GoTest (TUGT)49A timed test of functional mobilityconsisting of time it takes to rise from achair, walk three meters, turn around,walk back to the chair, and sit down.Good test-retest reliability inPD (ICCs 0.80)36,50 andexcellent interraterreliability (r 0.99) in PD51ActivPALActivity monitor(PALTechnologies Ltd,50 Richmond St,Glasgow G1 1XP,United Kingdom)Electronic device measuring fivecomponents: hours standing, hoursstepping, hours sitting or lying,up/down transitions, and metabolicequivalent of tasksInter-device reliability ofstep number and cadence:ICC (2,1) 0.9953Zung AnxietyScale (ZAS)56Beck DepressionInventory (BDI)58A self-rating instrument for anxietydisorders with 20 items that areidentified by a little, some, a good part,or most of the time. Scores range from20 to 80 with a higher score suggestiveof more anxiety.Most widely used instrument formeasuring the severity of depressionbased on symptoms from 21-itemsrated by the individual on a 0-3 scale.Scores range from 0 to 63 with higherscores indicative of more depression.Evidence forvalidityAble to discriminatephysically active fromsedentary older adults48and also exercisers andnon-exercisers47Moderate to goodconvergent validityevidence in PD (correlatedwith the BBS (r -0.78),fast gait speed (r -0.69),and comfortable gaitspeed (r -0.67)52Absolute percentage oferror 1% for outdoorambulation, 2% forwalking speeds of 0.67 m/s,54 sedentarybehavior validated againstdirect observation(R2 .94)55Good item-totalcorrelations and a goodtest–retest reliability in nonPD populations57In non-PD patients it hasshown to be sensitive tochange in treatmentstudies of anxiety57Cronbach’s 0.88 and ICC 0.89 in patients with PD5985.67% - 88.0% areaunder the ROC curve fordistinguishing depressedfrom non-depressed inPD59,60

Appendix E. Benjamini-Hochberg procedure table. Statistically significant p values are in red.Socioeconomic StatusFalls in the last monthUp/down transitionsAgeMDS-UPDRS IV (Motor complications)Injurious falls in last yearEducationHoehn & Yahr StageGenderMini-Mental State ExamFalls in the last yearPDQ Social supportHours sitting/laying down per dayDiagnosis yearHours standing per dayImpact of Events Scale - avoidancePDQ CommunicationImpact of Events Scale – hyperarousalImpact of Events Scale - revised30 Second Sit-To-Stand TestZung Anxiety ScaleImpact of Events Scale - intrusionHours stepping per dayPDQ EmotionMetabolic equivalents per dayPDQ CognitionPDQ StigmaBeck Depression InventoryMDS-UPDRS III (Motor)Steps taken in a dayParkinson’s disease subtypeTimed Up and Go TestMDS-UPDRS I (non-motor experiences of daily living)PDQ Bodily discomfortBerg Balance ScaleMovement Disorders Society (MDS)-UPDRSMDS-UPDRS II (motor experiences of daily living)Parkinson’s Disease Questionnaire (PDQ)-39PDQ MobilityActivities-Specific Balance Confidence ScaleConsequences of Falls QuestionnairePDQ ADLsp 050.00050.00050.0005rank 9181716151413121110987654321(j/m) 20.0011

Activities-Specific Balance Confidence Scale (ABC)39 Subjective rating of balance confidence with 16 different ambulatory activities. Items are rated on a rating scale of 0 to 100 with higher scores representing more confidence. The ABC score is the average subjective rating of all 16 items. Excellent test-retest reliability in PD (ICC 0.96 .