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Hulbert S.1, Ashburn A.1, Goodwin V.2, Chivers-Seymour K.1, Roberts H.3, Fitton C.1, Nieuwboer A.4, Rochester L.5
1University of Southampton, Faculty of Health Sciences, Southampton, United Kingdom, 2University of Exeter, NIHR CLAHRC South West Peninsula, Exeter, United Kingdom, 3University of Southampton, Faculty of Medicine, Southampton, United Kingdom, 4University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium, 5Newcastle University, Clinical Ageing Research Unit, Newcastle, United Kingdom
Background: Parkinson's is a progressive neurodegenerative movement disorder affecting 1 in 500 of the population, with an estimated 10 million cases worldwide.
Falling is one of the most disabling consequences of Parkinson's. 40-70% of people with Parkinson's (PwP) fall each year and one third fall repeatedly. These figures are double those reported for comparative elderly populations.
Parkinson's manifests in a spectrum of motor and non-motor symptom with current medical management showing minimal impact to reduce falls, or risk factors such as deficits in gait, strength and postural instability. Despite substantial, moderate level evidence and positive findings from meta-analysis supporting rehabilitation to reduce falls risk factors in PwP, the efficacy on reducing falls rate remains inconclusive.
Falling is one of the most disabling consequences of Parkinson's. 40-70% of people with Parkinson's (PwP) fall each year and one third fall repeatedly. These figures are double those reported for comparative elderly populations.
Parkinson's manifests in a spectrum of motor and non-motor symptom with current medical management showing minimal impact to reduce falls, or risk factors such as deficits in gait, strength and postural instability. Despite substantial, moderate level evidence and positive findings from meta-analysis supporting rehabilitation to reduce falls risk factors in PwP, the efficacy on reducing falls rate remains inconclusive.
Purpose: The aim is to
1) synthesise the current evidence base and conceptual models of falls rehabilitation in Parkinson's; and
2) introduce the treatment protocol used in the falls prevention, multi-centre clinical trial 'PDSAFE' and discuss the physiological underpinning.
1) synthesise the current evidence base and conceptual models of falls rehabilitation in Parkinson's; and
2) introduce the treatment protocol used in the falls prevention, multi-centre clinical trial 'PDSAFE' and discuss the physiological underpinning.
Methods: Four bibliographic databases were searched from 1990 2016, using the search terms Parkinson*, Rehabilitat*, Fall*, Balanc*, Strength*, Strategy*and Exercis*. All papers investigating rehabilitation in Parkinsons were selected then refined by title and abstract, as well as citation review. Due to the heterogeneous nature of studies, results were used to construct a narrative review with conceptual discussion, leading to presentation of the PDsafe intervention protocol.
Results: 1452 papers are initially reviewed, 398 selected by title and abstract and additional 4 by citation. The majority of studies report the impact of rehabilitation on single falls risk factors, with seven measuring the impact on overall falls frequency. Results are divided with four papers showing a significant reduction in falls rate and three showing no statistically significant difference. Studies are diverse in terms of population, methodology, intervention and clinical application.
Review findings highlight multi-model treatment models, addressing all components of the International Classification of Functioning, may be favourable compared to single factor treatment models related to isolated impairments in reducing overall falls rate. Key factors that contribute to the efficacy of such interventions, for example: - adherence, motivation and intensity are identified.
The PDSAFE intervention is a multimodal physiotherapist delivered, individually tailored and progressive, home-based programme currently being tested in a large (n = 541) multi-centred, single-blinded, randomised control trial (results available September 2017).
Conclusion(s): The evidence suggests purely training single falls risk factors does not have an effect on the overall incidence of falls and may be a potential mechanism for failure to show changes in falls rate in previous literature. Training single, risk factors alongside behavioural, strategy training in a functional, personalised multi-modal model is likely to provide a greater influence on falls reduction.
Implications: Review results alongside a description of PDSAFE intervention builds on the conceptual discussion of multi-dimensional interventions for falls prevention among PwP, informing the design and implementation of clinical practice and research.
Funding acknowledgements: NIHR Heath Technologies Assessments - HTA Project Reference: 10/57/21
Topic: Neurology: Parkinson's disease
Ethics approval: Ethics REC ref: 14/SC/0039 NRES South Central Hampshire B Committee
All authors, affiliations and abstracts have been published as submitted.
