Journal
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY
Volume 90, Issue 7, Pages 774-782Publisher
BMJ PUBLISHING GROUP
DOI: 10.1136/jnnp-2018-319448
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Funding
- National Institute for Health Research (NIHR) HTA programme [10/57/21]
- NIHR Collaboration for Leadership in Applied Health Research and Care at Oxford Health NHS Trust
- Oxford Biomedical Research Centre at the Oxford University Hospital Trust
- CLAHRC Oxford
- NIHR Collaboration for Leadership in Applied Health Research and Care in the South West Peninsula (PenCLAHRC)
- NIHR Newcastle Biomedical Research Centre (BRC) based at Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University
- NIHR Newcastle CRF Infrastructure funding
- CLAHRC Wessex
- NIHR Southampton Biomedical Research Centre
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Objective To estimate the effect of a physiotherapist-delivered fall prevention programme for people with Parkinson's (PwP). Methods People at risk of falls with confirmed Parkinson's were recruited to this multicentre, pragmatic, investigator blind, individually randomised controlled trial with prespecified subgroup analyses. 474 PwP (Hoehn and Yahr 1-4) were randomised: 238 allocated to a physiotherapy programme and 236 to control. All participants had routine care; the control group received a DVD about Parkinson's and single advice session at trial completion. The intervention group (PDSAFE) had an individually tailored, progressive home-based fall avoidance strategy training programme with balance and strengthening exercises. The primary outcome was risk of repeat falling, collected by self-report monthly diaries, 0-6 months after randomisation. Secondary outcomes included Mini-BESTest for balance, chair stand test, falls efficacy, freezing of gait, health-related quality of life (EuroQol EQ-5D), Geriatric Depression Scale, Physical Activity Scale for the Elderly and Parkinson's Disease Questionnaire, fractures and rate of near falling. Results Average age is 72 years and 266 (56%) were men. By 6 months, 116 (55%) of the control group and 125 (61.5%) of the intervention group reported repeat falls (controlled OR 1.21, 95% CI 0.74 to 1.98, p=0.447). Secondary subgroup analyses suggested a different response to the intervention between moderate and severe disease severity groups. Balance, falls efficacy and chair stand time improved with near falls reduced in the intervention arm. Conclusion PDSAFE did not reduce falling in this pragmatic trial of PwP. Other functional tasks improved and reduced fall rates were apparent among those with moderate disease.
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