Multicentre, randomised controlled trial of PDSAFE, a physiotherapist-delivered fall prevention programme for people with Parkinson’s

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 p...

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Autores principales: Chivers Seymour, Kim, Pickering, Ruth, Rochester, Lynn, Roberts, Helen C, Ballinger, Claire, Hulbert, Sophia, Kunkel, Dorit, Marian, Ioana R, Fitton, Carolyn, McIntosh, Emma, Goodwin, Victoria A, Nieuwboer, Alice, Lamb, Sarah E, Ashburn, Ann
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6585265/
https://www.ncbi.nlm.nih.gov/pubmed/30944149
http://dx.doi.org/10.1136/jnnp-2018-319448
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author Chivers Seymour, Kim
Pickering, Ruth
Rochester, Lynn
Roberts, Helen C
Ballinger, Claire
Hulbert, Sophia
Kunkel, Dorit
Marian, Ioana R
Fitton, Carolyn
McIntosh, Emma
Goodwin, Victoria A
Nieuwboer, Alice
Lamb, Sarah E
Ashburn, Ann
author_facet Chivers Seymour, Kim
Pickering, Ruth
Rochester, Lynn
Roberts, Helen C
Ballinger, Claire
Hulbert, Sophia
Kunkel, Dorit
Marian, Ioana R
Fitton, Carolyn
McIntosh, Emma
Goodwin, Victoria A
Nieuwboer, Alice
Lamb, Sarah E
Ashburn, Ann
author_sort Chivers Seymour, Kim
collection PubMed
description 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. TRIAL REGISTRATION NUMBER: ISRCTN48152791.
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spelling pubmed-65852652019-07-05 Multicentre, randomised controlled trial of PDSAFE, a physiotherapist-delivered fall prevention programme for people with Parkinson’s Chivers Seymour, Kim Pickering, Ruth Rochester, Lynn Roberts, Helen C Ballinger, Claire Hulbert, Sophia Kunkel, Dorit Marian, Ioana R Fitton, Carolyn McIntosh, Emma Goodwin, Victoria A Nieuwboer, Alice Lamb, Sarah E Ashburn, Ann J Neurol Neurosurg Psychiatry Movement Disorders 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. TRIAL REGISTRATION NUMBER: ISRCTN48152791. BMJ Publishing Group 2019-07 2019-04-03 /pmc/articles/PMC6585265/ /pubmed/30944149 http://dx.doi.org/10.1136/jnnp-2018-319448 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Movement Disorders
Chivers Seymour, Kim
Pickering, Ruth
Rochester, Lynn
Roberts, Helen C
Ballinger, Claire
Hulbert, Sophia
Kunkel, Dorit
Marian, Ioana R
Fitton, Carolyn
McIntosh, Emma
Goodwin, Victoria A
Nieuwboer, Alice
Lamb, Sarah E
Ashburn, Ann
Multicentre, randomised controlled trial of PDSAFE, a physiotherapist-delivered fall prevention programme for people with Parkinson’s
title Multicentre, randomised controlled trial of PDSAFE, a physiotherapist-delivered fall prevention programme for people with Parkinson’s
title_full Multicentre, randomised controlled trial of PDSAFE, a physiotherapist-delivered fall prevention programme for people with Parkinson’s
title_fullStr Multicentre, randomised controlled trial of PDSAFE, a physiotherapist-delivered fall prevention programme for people with Parkinson’s
title_full_unstemmed Multicentre, randomised controlled trial of PDSAFE, a physiotherapist-delivered fall prevention programme for people with Parkinson’s
title_short Multicentre, randomised controlled trial of PDSAFE, a physiotherapist-delivered fall prevention programme for people with Parkinson’s
title_sort multicentre, randomised controlled trial of pdsafe, a physiotherapist-delivered fall prevention programme for people with parkinson’s
topic Movement Disorders
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6585265/
https://www.ncbi.nlm.nih.gov/pubmed/30944149
http://dx.doi.org/10.1136/jnnp-2018-319448
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