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

Abstract

Background: Parkinson’s disease demonstrates a spectrum of motor and non-motor symptoms. Falling is common and disabling. Current medical management shows minimal impact to reduce falls or fall-related risk factors, such as deficits in gait, strength, and postural instability. Despite evidence supporting rehabilitation in reducing fall risk factors, the most appropriate intervention to reduce overall fall rate remains inconclusive. This article aims to 1) synthesise current evidence and conceptual models of falls rehabilitation in Parkinson’s in a narrative review; and based on this evidence, 2) introduce the treatment protocol used in the falls prevention and multi-centre clinical trial “PDSAFE”.

Method: Search of four bibliographic databases using the terms “Parkinson*” and “Fall*” combined with each of the following; “Rehab*, Balanc*, Strength*, Strateg*and Exercis*” and a framework for narrative review was followed. A total of 3557 papers were identified, 416 were selected for review. The majority report the impact of rehabilitation on isolated fall risk factors. Twelve directly measure the impact on overall fall rate.

Discussion: Results were used to construct a narrative review with conceptual discussion based on the “International Classification of Functioning”, leading to presentation of the “PDSAFE” intervention protocol.

Conclusions: Evidence suggests training single, fall risk factors may not affect overall fall rate. Combining with behavioural and strategy training in a functional, personalised multi-dimensional model, addressing all components of the “International Classification of Functioning” is likely to provide a greater influence on falls reduction. “PDSAFE” is a multi-dimensional, physiotherapist delivered, individually tailored, progressive, home-based programme. It is designed with a strong evidence-based approach and illustrates a model for the clinical delivery of the conceptual theory discussed.

Implications for Rehabilitation

• Parkinson’s disease demonstrates a spectrum of motor and non-motor symptoms, where falling is common and disabling.

• Current medical and surgical management have minimal impact on falls, rehabilitation of falls risk factors has strong evidence but the most appropriate intervention to reduce overall fall rate remains inconclusive.

• Addressing all components of the International Classification of Function in a multifactorial model when designing falls rehabilitation interventions may be more effective at reducing fall rates in people with Parkinson’s than treating isolated risk factors.

• The clinical model for falls rehabilitation in people with Parkinson’s should be multi-dimensional.

Keywords:

• Parkinson’s
• falls
• rehabilitation
• International Classification of Function

Acknowledgements

The PDSAFE Collaborative Group is made up of Prof Ann Ashburn Dr Kim Seymour, Dr Claire Ballinger, Dr Helen Roberts, Dr Ruth Pickering (University of Southampton); Prof Sallie Lamb (Oxford Clinical Trials Research Unit); Dr Emma McIntosh (University of Glasgow); Dr Vicki Goodwin (University of Exeter); Prof Lynn Rochester (University of Newcastle); and Prof Alice Nieuwboer (KU Leuven).

Disclosure statement

The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the funders or the Department of Health.

Additional information

Funding

This project was funded by the National Institute for Health Research Health Technologies Assessment programme (project number 10/57/21). VG is supported by the National Institute of Health Research Collaboration for Applied Health Research and Care South West Peninsula.