Perspectives of People with Parkinson’s Disease and their Care-partners on a Multidomain Fall Prevention Program (Integrate)

Introduction

Falls are frequent amongst people with Parkinson’s disease (PwP), and increase as disease progresses. Exercise can reduce falls, but rates remain high and exercise alone is ineffective in people with more advanced disease. Personalised multidomain fall prevention programs delivered by a multidisciplinary team of clinicians may be more effective. This study explored the acceptability of a multidomain fall prevention program (Integrate) for PwP who fell recurrently and their care-partners, and factors influencing engagement.

Methods

This qualitative study used inductive thematic analysis of eighteen purposively sampled semi-structured interviews conducted after participants completed Integrate. The program was personalised and collaborative, delivered by occupational therapists and physiotherapists over 8-12 home visits in 6 months. It included home-fall hazard reduction, exercise (leg strength, balance, freezing of gait) and safer mobility strategies.    

Results

Five themes were identified: 1) the importance of personalisation, 2) a collaborative effort, 3) capacity building, 4) navigating fall risk with Parkinson’s is complex, and 5) the ease (or not) of making changes. PwP and their care-partners valued the home-based and personalised program delivered by expert therapists that involved shared decision-making. They were more aware of their safety when mobilising and developed better problem-solving skills. PwP were more engaged if they could see improvements and received ongoing support from therapists and care-partners. However, some PwP faced emotional and psychological barriers to engagement as they held fatalistic beliefs about disease progression and wanted to avoid appearing ‘disabled’. The reality of Parkinson’s disease motivated PwP to make changes but Parkinson’s-related impairments such as apathy and motor fluctuations hindered this.

Conclusions

PwP who fall recurrently, and their care-partners, found the Integrate program acceptable and were able to engage with it with guidance and support from therapists. Psychological and emotional support is important to help PwP overcome barriers and adopt changes.