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

Chivers Seymour, K. et al. (2019) Multicentre, randomised controlled trial of PDSAFE, a physiotherapist-delivered fall prevention programme for people with Parkinson’s. Journal of Neurology, Neurosurgery and Psychiatry, (doi:10.1136/jnnp-2018-319448) (PMID:30944149) (Early Online Publication)

[img]
Preview
Text
183610.pdf - Published Version
Available under License Creative Commons Attribution Non-commercial.

2MB

Abstract

Objective: To estimate the effect of a physiotherapist-delivered fall prevention programme for people with Parkinson’s (PwP). Methods: People 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. Results: Average 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. Conclusion: PDSAFE 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 number: ISRCTN48152791.

Item Type:Articles
Additional Information:The project was funded by the National Institute for Health Research (NIHR) HTA programme (project number 10/57/21). SEL is funded by the NIHR Collaboration for Leadership in Applied Health Research and Care at Oxford Health NHS Trust and the Oxford Biomedical Research Centre at the Oxford University Hospital Trust, and CLAHRC Oxford. VG is supported by the NIHR Collaboration for Leadership in Applied Health Research and Care in the South West Peninsula (PenCLAHRC). LR is supported by the NIHR Newcastle Biomedical Research Centre (BRC) based at Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University. The research was also supported by NIHR Newcastle CRF Infrastructure funding. HR is supported by CLAHRC Wessex and NIHR Southampton Biomedical Research Centre.
Status:Early Online Publication
Refereed:Yes
Glasgow Author(s) Enlighten ID:McIntosh, Professor Emma
Authors: Chivers Seymour, 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., and Ashburn, A.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Health Economics and Health Technology Assessment
Journal Name:Journal of Neurology, Neurosurgery and Psychiatry
Publisher:BMJ Publishing Group
ISSN:0022-3050
ISSN (Online):1468-330X
Published Online:03 April 2019
Copyright Holders:Copyright © 2019 The Authors
First Published:First published in Journal of Neurology, Neurosurgery and Psychiatry 2019
Publisher Policy:Reproduced under a Creative Commons License

University Staff: Request a correction | Enlighten Editors: Update this record

Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
608681A Randomised Controlled Trial of the Effectiveness of PDSAFE to prevent Falls among People with Parkinson's DiseaseEmma McIntoshNational Institute for Health Research (NIHR)10/57/21IHW - HEALTH ECON & TECH ASSESSMENT