Healthcare professionals' experiences of managing turning difficulties in Parkinson's disease: A qualitative interview study

Background: Turning difficulties are a disabling motor symptom in Parkinson’s disease (PD), often contributing to falls and reduced mobility. Despite their clinical significance, turning problems remain challenging to manage, with current interventions offering limited and inconsistent benefits. Pharmacological treatments rarely address complex gait impairments such as turning, while rehabilitation strategies - physiotherapy and cueing - show promise but vary widely in application and effectiveness. Understanding how these approaches are perceived and implemented in practice is essential for improving care and reducing falls risk in PD. This study explores current strategies for managing turning difficulties through qualitative interviews with healthcare professionals (HCPs), aiming to identify gaps, challenges, and opportunities for more targeted interventions.

Method: Semi-structured online interviews were conducted with 15 UK-based HCPs (14 Physiotherapists and 1 Occupational Therapist) with experience of working with people with PD. Audio recordings were transcribed and thematically analysed.

Results: Three overarching themes were identified: i. Clinical understanding and management of turning problems; ii. Systemic and organisational influences; iii. Practitioner reflections. Falls during turning led to injuries ranging from minor to severe, with some HCPs observing that patients sustaining hip fractures were diverted to orthopaedic pathways, potentially missing out on Parkinson’s specialist input for falls prevention and rehabilitation.  HCPs reported reliance on subjective assessments and generic balance and mobility outcomes, with turning problems often under-recognized and under-reported by patients. Individualised strategies—such as external cueing, environmental modifications, and tailored physiotherapy—were considered essential, yet gaps in knowledge, training, and guidance persist.

Conclusion: Greater awareness of turning difficulties and integration of management strategies into professional education may optimise care. Future research should develop and evaluate interventions specifically targeting turning to reduce falls and enhance mobility in PD.