The Integrate program for safe mobility in Parkinson's Disease.

The intervention will be a 6 month multi factorial home-based program (ie. multiple interventions tailored to the individual and targeting their mobility related goals) designed to improve for safe mobility and reduce falls in people with Parkinson's Disease. Participants will undertake the intervention in addition to their usual care. The intervention will consist of environmental modification, behavioral modification and exercise which will be delivered to participants in their homes by trained occupational therapists and physiotherapists. Participants will receive 8-12 therapy home visits over a 6 month period depending on their need. The components of the program will be designed in collaboration with the person with PD and any care partner. The ratio of physiotherapy and occupational therapy home visits will depend on each participants physical abilities, functional cognition, ability to engage with the different components of the intervention, identified goals and issues of safety. Participants will receive regular phone calls (at least 5 phone calls during the intervention period) to monitor progress and address any problems arising related to the intervention. 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 falls 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. Situational cues will be used as prompts to reinforce goal directed behavior. Participants will be provided with a home safety booklet which will be adapted to their cognitive abilities and will outline recommendations. The booklets will be designed by the research team specifically for this trial. The home based exercise component of the program will be individually prescribed and delivered to participants in their homes by an experienced Physiotherapist and will include commonly used exercises for fall prevention (www.webb.org.au) and PD specific exercises available at www.physiotherapyexercises.com. These exercises are known remedial risk factors for falls in people with PD (ie. leg muscle weakness, poor standing balance and freezing of gait). Exercises will be prescribed to be performed in 30 minute sessions, between 3-5 times per week. In order to maximize efficiency and minimize adverse events, programs will be individually prescribed and progressed according to participants 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, designed by research staff specifically for the trial, which will include clear pictorial and simple written instructions, as well as precautions and instructions to advise study staff and /or their medical practitioner if they experience any major adverse effects from the exercise. They will also be provided with a log book to record completed exercises and any effects of the exercise (eg. muscle soreness).