None listed
Conditions
Brief summary
Despite advances in management, falls continue to be a major problem for people with Parkinson’s disease (PD). Most falls prevention research excludes people with PD with cognitive impairment; however these are the people most at risk of falls. The objective of this study is to determine the feasibility and acceptability of a multifactorial fall prevention program and assessment for people with PD, including people with impaired cognition and freezing of gait. A mixed methods study with a single group trial of a 4 to 6 month multifactorial home-based fall prevention intervention will be conducted. The intervention will consist of behavioural modification, environmental modification and exercise. The intervention will be delivered by physiotherapists and occupational therapists. Semi-structured interviews will be conducted with participants before and after the intervention. Before the intervention the interview will explore participant’s perceptions of risk and their response to this perceived risk, and after the intervention questions will explore intervention acceptability.
Interventions
The intervention will be a multifactorial fall prevention program (i.e. multiple interventions tailored to the individual and targeting their specific fall risk factors) which will run for 4-6 months (depending on the participant's needs). The intervention will consist of environmental modification, behavioural modification and exercise, which will be delivered to participants in their homes by occupational therapists and physiotherapists. Participants will receive 6 to 12 therapy home visits
The intervention will be a multifactorial fall prevention program (i.e. multiple interventions tailored to the individual and targeting their specific fall risk factors) which will run for 4-6 months (depending on the participant's needs). The intervention will consist of environmental modification, behavioural modification and exercise, which will be delivered to participants in their homes by occupational therapists and physiotherapists. Participants will receive 6 to 12 therapy home visits depending on their need. The ratio of physiotherapy and occupational therapy home visits will depend on each participant’s physical abilities, functional cognition, ability to engage with the different components of the intervention, identified goals and issues of safety. All participants will receive weekly phone calls between visits to monitor progress and address any intervention related problems which arise. The environmental and behavioural components of the program will be delivered as a home and community safety package. Strategies will be discussed with the participant (and any care-partner), and implemented through the use of diaries and goal setting. Environmental adaptations to reduce fall risk will be introduced (eg, removal of clutter, improving lighting) and participants who display unsafe patterns of movement will be taught how to use cues and strategies to initiate and maintain safe movement. Participants with be provided with a home safety booklet which will be adapted to their cognitive abilities and will outline recommendations. Situational cues will be used as prompts to reinforce behaviour. Adherence to the environmental and behavioural components of the program will be monitored by the occupational therapist through discussions with the participant and any care-partner and the use of participant diaries. The home-based exercise component of the program will be individually prescribed and delivered and will include commonly used exercises for fall prevention (www.webb.org.au) These exercises address known remediable risk factors for falls in people with PD (i.e. leg muscle weakness, poor balance and freezing of gait). Exercises will be performed in 30 minute sessions, up to 6 times per week. In order to maximise efficacy and minimise adverse events, programs will be individually prescribed and progressed according to the participant’s physical and cognitive abilities. Participants will be shown how to exercise with a stable support nearby if necessary. Exercises will also be taught to any care-partner who will provide supervision and assistance (including appropriate cueing) as required. Participants and any care partner will be provided with an exercise booklet which will include clear pictorial and simple written instructions, as well as a log book in which they will record completed exercise.
Sponsors
The University of Sydney
Study design
Allocation
Non-randomised trial
Intervention model
Single group
Primary purpose
Prevention
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
40 Years to No maximum
Healthy volunteers
No
Inclusion criteria
At least 1 fall in the prior 6 months No change to Parkinson's disease medications in the 2 weeks prior to commencing the study Able to walk at least 10 m with or without a walking aid Participants with significant cognitive impairment (Montreal Cognitive Assessment <19 or, a level of functional cognition that the researchers deem requires assistance to participate) will require an able care-partner who is willing to participate with them to assist them with the intervention.
Exclusion criteria
Medical conditions which would preclude or interfere with study safety and conduct. Severe cognitive impairment (Montreal Cognitive Assessment <5)
Outcome results
None listed