Parkinson's disease: fall-prevention program nets mixed results

  • J Neurol Neurosurg Psychiatry

  • von Susan London
  • Clinical Essentials
Der Zugang zum gesamten Inhalt dieser Seite ist nur Angehörigen medizinischer Fachkreise vorbehalten. Der Zugang zum gesamten Inhalt dieser Seite ist nur Angehörigen medizinischer Fachkreise vorbehalten.

Takeaway

  • The physiotherapist-delivered PDSAFE intervention did not reduce risk for falls among patients with Parkinson’s disease overall, but possibly did among those with only moderate disease.

Why this matters

  • High prevalence, morbidity of falls.

Key results

  • 6-month rate of repeat falls: 61.5% in the intervention group, 55% in the control group (controlled OR, 1.21; P=.447).
  • Outcomes favoring intervention:
    • Near falls (OR, 0.67; P=.001).
    • Balance (difference in Mini-BESTest score, 0.95 points; P=.009).
    • Falls Efficacy Scale score (difference, 1.60 points; P=.026).
    • Chair stand test time (12 vs 13 seconds; P=.041).
  • Possible benefit of intervention (P for interaction=.009 to .089) in reducing falls for patients:
    • Not having freezing of gait.
    • Less/not impaired on Montreal Cognitive Assessment.
    • With intermediate Unified Parkinson’s Disease Rating Scale score.
    • Having 2-3 falls in the last year.

Study design

  • UK multicenter randomized controlled trial among 474 patients with Parkinson’s disease (Hoehn and Yahr stage I-IV) experiencing ≥1 fall in the last year.
  • Randomization: physiotherapist-delivered intervention (individually tailored, progressive home-based fall-avoidance strategy training program with balance, strengthening exercises) vs control (DVD about disease, single advice session).
  • Main outcome: risk for repeat falling from self-report monthly diaries.
  • Funding: National Institute for Health Research.

Limitations

  • Unclear generalizability.
  • Lack of complete 12-month follow-up.