“Staying safe” – a narrative review of falls prevention in people with Parkinson’s – “PDSAFE”

Hulbert, Sophia; Rochester, Lynn; Nieuwboer, Alice; Goodwin, Vicki; Fitton, Carolyn; Chivers-Seymour, Kim; Ashburn, Ann

doi:10.1080/09638288.2018.1471167

Cited by 17 publications

(26 citation statements)

References 79 publications

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“…Owing to the complexity of the exercises, some exercises are better able to be adapted for multiple impairments and thus are used more frequently. Previous studies 19 have provided the same intervention for all participants, regardless of fall mechanism. The use of all the strategies and exercises demonstrates the need for a complex intervention and variability as 'one size, clearly does not fit all'.…”

Section: Discussionmentioning

confidence: 99%

“…Instead, a multidimensional model that combines functional exercises with behavioural strategies is likely to provide a greater influence on reducing falls. 19 PDSAFE is an example of a multidimensional programme. 19 It is an individualised, home-based, physiotherapist-delivered, personalised treatment programme of exercises and strategies to help prevent falls in Parkinson's.…”

Section: Falls Preventionmentioning

confidence: 99%

“…19 PDSAFE is an example of a multidimensional programme. 19 It is an individualised, home-based, physiotherapist-delivered, personalised treatment programme of exercises and strategies to help prevent falls in Parkinson's. The novelty lies in both the content (i.e.…”

Section: Falls Preventionmentioning

confidence: 99%

“…Evidence suggests that a multidimensional intervention to reduce falls, incorporating balance, functional strength and strategy training, and thus appreciating the need for motor, cognitive and behavioural training, may be more effective than interventions focusing on independent risk factors such as postural control and/or functional strength alone. 19 The PDSAFE intervention is delivered in the home, tailored to an individual's specific falls mechanism and functional presentation and personalised to rehabilitate the primary strategy or strategies that contributed to the fall(s) ( Figure 2). Not only does this allow the protocol to align with all components of the International Classification of Functioning, Disability and Health (ICF) 44 as a person-centred approach, it also follows the consensus-based clinical practice recommendations for falls management in Parkinson's.…”

Section: Background For Intervention Designmentioning

confidence: 99%

“…Evidence from the literature and from previous studies of falls among patients with Parkinson's, as well as expert opinion, were used to determine the most frequent falls mechanisms in Parkinson's. 19 Eight strategies were defined: avoiding tripping, dual tasking, freezing cues, moving in tight spaces, picking up an object, reaching, stepping backwards and turning. As described above, through the process of taking a detailed falls history, clinical assessment and advanced clinical reasoning, therapists determined the most likely 'fall mechanism' for each participant (levels 1 and 2 in Figure 2).…”

Section: Selection Of Strategiesmentioning

confidence: 99%

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Exercise- and strategy-based physiotherapy-delivered intervention for preventing repeat falls in people with Parkinson’s: the PDSAFE RCT

Ashburn

Pickering

McIntosh

et al. 2019

Health Technol Assess

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Background People with Parkinson’s disease are twice as likely to experience a fall as a healthy older person, often leading to debilitating effects on confidence, activity levels and quality of life. Objective To estimate the effect of a physiotherapy programme for fall prevention among people with Parkinson’s disease. Design A multicentre, pragmatic, investigator-masked, individually randomised controlled trial (RCT) with prespecified subgroup analyses. Setting Recruitment from NHS hospitals and clinics and community and social services in eight English regions with home-based interventions. Participants A total of 474 people with Parkinson’s disease (i.e. Hoehn and Yahr scale stages 1–4) were recruited: 238 were assigned to a physiotherapy programme and 236 were assigned to usual care. Random allocation was 50 : 50. Interventions All participants received routine care; the usual-care group received an information digital versatile disc (DVD) and a single advice session at trial completion. The intervention group had an individually tailored, progressive, home-based fall avoidance strategy training programme with balance and strengthening exercises: PDSAFE. Main outcome measures The primary outcome was the risk of repeat falling, collected by self-report monthly diaries between 0 and 6 months after randomisation. Secondary outcomes included near-falls, falls efficacy, freezing of gait (FoG), health-related quality of life, and measurements taken using the Mini-Balance Evaluation Systems Test (Mini-BESTest), the Chair Stand Test (CST), the Geriatric Depression Scale, the Physical Activity Scale for the Elderly and the Parkinson’s Disease Questionnaire. Results PDSAFE is the largest RCT of falls management among people with Parkinson’s disease: 541 patients were screened for eligibility. The average age was 72 years, and 266 out of 474 (56%) participants were men. Of the 474 randomised participants, 238 were randomised to the intervention group and 236 were randomised to the control group. No difference in repeat falling within 6 months of randomisation was found [PDSAFE group to control group odds ratio (OR) 1.21, 95% confidence interval (CI) 0.74 to 1.98; p = 0.447]. An analysis of secondary outcomes demonstrated better balance (Mini-BESTest: mean difference 0.95, 95% CI 0.24 to 1.67; p = 0.009), functional strength (CST: p = 0.041) and falls efficacy (Falls Efficacy Scale – International: mean difference 1.6, 95% CI –3.0 to –0.19; p = 0.026) with near-falling significantly reduced with PDSAFE (OR 0.67, 95% CI 0.53 to 0.86; p = 0.001) at 6 months. Prespecified subgroup analysis (i.e. disease severity and FoG) revealed a PDSAFE differing effect; the intervention may be of benefit for people with moderate disease but may increase falling for those in the more severe category, especially those with FoG. Limitations All participants were assessed at primary outcome; only 73% were assessed at 12 months owing to restricted funding. Conclusions PDSAFE was not effective in reducing repeat falling across the range of people with Parkinson’s disease in the trial. Secondary analysis demonstrated that other functional tasks and self-efficacy improved and demonstrated differential patterns of intervention impact in accordance with disease severity and FoG, which supports previous secondary research findings and merits further primary evaluation. Future work Further trials of falls prevention on targeted groups of people with Parkinson’s disease are recommended. Trial registration Current Controlled Trials ISRCTN48152791. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 36. See the NIHR Journals Library website for further project information. Sarah E Lamb is funded by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) at Oxford Health NHS Foundation Trust, the NIHR Oxford Biomedical Research Centre at the Oxford University Hospitals NHS Foundation Trust and CLAHRC Oxford. Victoria A Goodwin is supported by the NIHR Collaborations for Leadership in Applied Health Research and Care in the South West Peninsula (PenCLAHRC). Lynn Rochester is supported by the NIHR Newcastle Biomedical Research Centre based at Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University. The research was also supported by the NIHR Newcastle Clinical Research Facility Infrastructure funding. Helen C Roberts is supported by CLAHRC Wessex and the NIHR Southampton Biomedical Research Centre.

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Section: Discussionmentioning

confidence: 99%

Section: Falls Preventionmentioning

confidence: 99%

Section: Falls Preventionmentioning

confidence: 99%

Section: Background For Intervention Designmentioning

confidence: 99%

Section: Selection Of Strategiesmentioning

confidence: 99%

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Exercise- and strategy-based physiotherapy-delivered intervention for preventing repeat falls in people with Parkinson’s: the PDSAFE RCT

Ashburn

Pickering

McIntosh

et al. 2019

Health Technol Assess

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Interventions for preventing falls in Parkinson's disease

Allen

Canning

Almeida

et al. 2022

Cochrane Database of Systematic Reviews

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Systematic review for the prevention and management of falls and fear of falling in patients with Parkinson's disease

et al. 2022

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Objective To synthesize recent empirical evidence for the prevention and management of falls and fear of falling in patients with Parkinson's disease (PD). Data source Database from PubMed, Cochrane Library, and EMBASE. Study design Systematic review. Data collection We searched the PubMed, Cochrane Library, and EMBASE databases for studies published from inception to February 27, 2021. Inclusion criteria were nonreview articles on prevention and management measures related to falls and fall prevention in Parkinson's disease patients. Principal findings We selected 45 articles and conducted in‐depth research and discussion. According to the causes of falls in PD patients, they were divided into five directions, namely physical status, pre‐existing conditions, environment, medical care, and cognition. In the cognitive domain, we focused on the fear of falling. On the above basis, we constructed a fall prevention model, which is a tertiary prevention health care network, based on The Johns Hopkins Fall Risk Assessment Tool to provide ideas for the prevention and management of falling and fear of falling in PD patients in clinical practice Conclusions Falls and fear of falls in patients with Parkinson's disease can be reduced by effective clinical prevention and management. Future studies are needed to explore the efficacy of treatment and prevention of falls and fear of falls.

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“Staying safe” – a narrative review of falls prevention in people with Parkinson’s – “PDSAFE”

Cited by 17 publications

References 79 publications

Exercise- and strategy-based physiotherapy-delivered intervention for preventing repeat falls in people with Parkinson’s: the PDSAFE RCT

Exercise- and strategy-based physiotherapy-delivered intervention for preventing repeat falls in people with Parkinson’s: the PDSAFE RCT

Interventions for preventing falls in Parkinson's disease

Systematic review for the prevention and management of falls and fear of falling in patients with Parkinson's disease

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