Feasibility of a Multidomain Fall Prevention Program (Integrate) for People with Parkinson’s Disease

Introduction

People with Parkinson’s disease (PwP) fall more often than the general older population. Exercise can reduce falls in those with mild to moderate disease but may increase falls as the disease progresses. Additionally, most non-pharmacological fall prevention trials have focused on those with mild to moderate disease and excluded PwP with cognitive impairment. This pilot study examined the feasibility and potential effectiveness of a multidomain fall prevention program (Integrate) for PwP with recurrent falls, including those with cognitive impairment.

Methods

A single group study of Integrate - a six-month, home-based, personalised program delivered by occupational therapists and physiotherapists - was conducted. The intervention included home fall-hazard reduction (e.g., decluttering, bathroom rails), exercise (for leg strength, balance, and freezing of gait) and training in safer mobility behaviours (e.g., taking care in risky situations). Participants received 8 to12 home visits and, where needed, support from a care-partner. The primary outcome was the feasibility of Integrate. Secondary outcomes included the Goal Attainment Scale, mobility and the rate of falls.

Results

Twenty-nine PwP with moderate to advanced disease and mild to moderate cognitive impairment were recruited (49% recruitment rate), 26 completed the study (10% drop-outs). Adherence was moderate to high and there were no adverse events related to the intervention. Twenty-one (81%) met or exceeded their safer mobility goal. Mobility (Short Physical Performance Battery) improved by a clinically meaningful median of 1.0 (0.5-1.5). Exploratory analysis indicated fall rates reduced by almost 50% during the six-month follow-up (IRR 0.51, 95% CI 0.28 –0.92).

Conclusions

A multidomain fall prevention program delivered by occupational therapists and physiotherapists for PwP with recurrent falls, including those with cognitive impairment, was feasible and appeared to reduce falls and improve mobility safety. A randomized trial powered to detect effects on falls is warranted.