Perturbation Training for Fall Prevention in Parkinson’s Disease (ReSteP): Protocol for a Randomized Controlled Trial

Introduction

People with Parkinson’s disease (PwPD) are at significantly increased risk of falling due to gait and balance impairments. Notably, reactive balance, which is essential for adequate motor responses to external perturbations, is particularly affected in this population. Perturbation-based balance training (PBT) specifically addresses this issue and has been shown to reduce fall rates by up to 50% in fall-prone older adults. The objective of this study is to evaluate the feasibility and efficacy of treadmill-based PBT in PwPD.

Method

In this randomized controlled trial, 90 PwPD (40 – 80 years, stage 1 – 3 on the Hoehn & Yahr Scale) will undergo twelve sessions of either treadmill-based PBT or conventional treadmill training. In the PBT group, perturbations will be applied during walking in anteroposterior and mediolateral directions with individually adjusted and progressively increasing intensity. The primary outcome is reactive balance, quantified with the Dynamic Stepping Threshold Test. Secondary outcomes include laboratory- and real-world falls, fear of falling, balance and gait measures, and the feasibility and acceptability of the intervention. Outcome measures will be assessed at baseline, post-intervention and at 6 months follow-up. Real-world falls will be additionally evaluated at 12 months follow-up.

Results

Based on the ecological validity of the approach and the observed results in other populations, we anticipate good feasibility and acceptability of PBT in PwPD. We hypothesize that PBT, compared to conventional training, will improve reactive balance, linked with a reduction of real-world falls. Comparable improvements in gait ability are expected in both groups, with no transfer effects of PBT to general balance function.

Conclusions

This RCT will provide the first robust data set on the efficacy and feasibility of treadmill-based PBT in PwPD. The insights have the potential to facilitate its implementation in neurorehabilitation, thereby improving the health care situation for PwPD.