Home based rehabilitation to reduce falls and disability in Parkinson's disease (PD)

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Falls and movement disorders are both common and disabling in people with idiopathic Parkinson's disease (PD), which affects more than 80,000 Australians. Whereas one-third of community dwelling elders fall every year, the incidence in people with PD is as high as 50-68%. Many people with PD experience repeated falls and over 25% sustain a hip fracture (as the result of falling) within 10 years of diagnosis. Along with balance impairment, movements progressively become slower and scaled down in size. Anti-PD medications initially provide effective symptomatic relief although movement disorders and postural instability again become problematic with disease progression. Preliminary trials have shown that hospital based movement rehabilitation programs are an effective adjunct to pharamacological therapy in the short term. Nevertheless hospital inpatient and outpatient programs are costly and can be inconvenient for some people who do not have transport. This randomised controlled trial will compare the outcomes of home based “integrated rehabilitation” with a control intervention in a sample of 180 people with PD. Participants in the treatment group will receive a 6 week home-based rehabilitation program comprising movement strategy training, progressive strengthening and education regarding falls and mobility, delivered by an experienced physiotherapist. The control group will receive a “life-skills” home program delivered by an allied health professional (physiotherapist, PD nurse or occupational therapist). The life-skills program will provide participants with education on relevant topics including PD pathology, medications and relaxation techniques, without falls education, strategies or exercises. Participants will undertake all assessments and interventions associated with this trial within their own home.