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

Seymour K Chivers; Ruth Pickering; Lynn Rochester; Helen C. Roberts; Claire Ballinger; Sophia Hulbert; Dorit Kunkel; Ioana R. Marian; Carolyn Fitton; Emma McIntosh; Victoria A. Goodwin; Alice Nieuwboer; Sarah E. Lamb; Ann Ashburn

doi:10.1136/jnnp-2018-319448

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

Seymour K Chivers, Ruth Pickering, Lynn Rochester, Helen C. Roberts, Claire Ballinger, Sophia Hulbert, Dorit Kunkel, Ioana R. Marian, Carolyn Fitton, Emma McIntosh, Victoria A. Goodwin, Alice Nieuwboer, Sarah E. Lamb, Ann Ashburn^*

^*Corresponding author for this work

School of Health Professions

Research output: Contribution to journal › Article › peer-review

Abstract

ObjectiveTo estimate the effect of a physiotherapist-delivered fall prevention programme for people with Parkinson’s (PwP).MethodsPeople 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.ResultsAverage 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.ConclusionPDSAFE 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 numberISRCTN48152791.

Original language	English
Pages (from-to)	774-782
Number of pages	0
Journal	Journal of Neurology, Neurosurgery & Psychiatry
Volume	90
Issue number	7
Early online date	3 Apr 2019
DOIs	https://doi.org/10.1136/jnnp-2018-319448
Publication status	Published - Jul 2019

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Chivers, S. K., Pickering, R., Rochester, L., Roberts, H. C., Ballinger, C., Hulbert, S., Kunkel, D., Marian, I. R., Fitton, C., McIntosh, E., Goodwin, V. A., Nieuwboer, A., Lamb, S. E., & Ashburn, A. (2019). Multicentre, randomised controlled trial of PDSAFE, a physiotherapist-delivered fall prevention programme for people with Parkinson’s. Journal of Neurology, Neurosurgery & Psychiatry, 90(7), 774-782. https://doi.org/10.1136/jnnp-2018-319448

@article{f440296b1aeb4fc29de04684d786fd71,

title = "Multicentre, randomised controlled trial of PDSAFE, a physiotherapist-delivered fall prevention programme for people with Parkinson{\textquoteright}s",

abstract = "ObjectiveTo estimate the effect of a physiotherapist-delivered fall prevention programme for people with Parkinson{\textquoteright}s (PwP).MethodsPeople at risk of falls with confirmed Parkinson{\textquoteright}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{\textquoteright}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{\textquoteright}s Disease Questionnaire, fractures and rate of near falling.ResultsAverage 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.ConclusionPDSAFE 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 numberISRCTN48152791.",

author = "Chivers, {Seymour K} and Ruth Pickering and Lynn Rochester and Roberts, {Helen C.} and Claire Ballinger and Sophia Hulbert and Dorit Kunkel and Marian, {Ioana R.} and Carolyn Fitton and Emma McIntosh and Goodwin, {Victoria A.} and Alice Nieuwboer and Lamb, {Sarah E.} and Ann Ashburn",

year = "2019",

month = jul,

doi = "10.1136/jnnp-2018-319448",

language = "English",

volume = "90",

pages = "774--782",

journal = "Journal of Neurology, Neurosurgery & Psychiatry",

issn = "0022-3050",

number = "7",

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Chivers, SK, Pickering, R, Rochester, L, Roberts, HC, Ballinger, C, Hulbert, S, Kunkel, D, Marian, IR, Fitton, C, McIntosh, E, Goodwin, VA, Nieuwboer, A, Lamb, SE & Ashburn, A 2019, 'Multicentre, randomised controlled trial of PDSAFE, a physiotherapist-delivered fall prevention programme for people with Parkinson’s', Journal of Neurology, Neurosurgery & Psychiatry, vol. 90, no. 7, pp. 774-782. https://doi.org/10.1136/jnnp-2018-319448

TY - JOUR

T1 - Multicentre, randomised controlled trial of PDSAFE, a physiotherapist-delivered fall prevention programme for people with Parkinson’s

AU - Chivers, Seymour K

AU - Pickering, Ruth

AU - Rochester, Lynn

AU - Roberts, Helen C.

AU - Ballinger, Claire

AU - Hulbert, Sophia

AU - Kunkel, Dorit

AU - Marian, Ioana R.

AU - Fitton, Carolyn

AU - McIntosh, Emma

AU - Goodwin, Victoria A.

AU - Nieuwboer, Alice

AU - Lamb, Sarah E.

AU - Ashburn, Ann

PY - 2019/7

Y1 - 2019/7

N2 - ObjectiveTo estimate the effect of a physiotherapist-delivered fall prevention programme for people with Parkinson’s (PwP).MethodsPeople 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.ResultsAverage 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.ConclusionPDSAFE 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 numberISRCTN48152791.

AB - ObjectiveTo estimate the effect of a physiotherapist-delivered fall prevention programme for people with Parkinson’s (PwP).MethodsPeople 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.ResultsAverage 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.ConclusionPDSAFE 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 numberISRCTN48152791.

U2 - 10.1136/jnnp-2018-319448

DO - 10.1136/jnnp-2018-319448

M3 - Article

SN - 0022-3050

VL - 90

SP - 774

EP - 782

JO - Journal of Neurology, Neurosurgery & Psychiatry

JF - Journal of Neurology, Neurosurgery & Psychiatry

IS - 7

ER -

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

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