The University of Southampton
University of Southampton Institutional Repository
Warning ePrints Soton is experiencing an issue with some file downloads not being available. We are working hard to fix this. Please bear with us.

“Staying safe”–a narrative review of falls prevention in people with Parkinson’s–“PDSAFE”

“Staying safe”–a narrative review of falls prevention in people with Parkinson’s–“PDSAFE”
“Staying safe”–a narrative review of falls prevention in people with Parkinson’s–“PDSAFE”

Background: Parkinson’s disease demonstrates a spectrum of motor and non-motor symptoms. Falling is common and disabling. Current medical management shows minimal impact to reduce falls or fall-related risk factors, such as deficits in gait, strength, and postural instability. Despite evidence supporting rehabilitation in reducing fall risk factors, the most appropriate intervention to reduce overall fall rate remains inconclusive. This article aims to 1) synthesise current evidence and conceptual models of falls rehabilitation in Parkinson’s in a narrative review; and based on this evidence, 2) introduce the treatment protocol used in the falls prevention and multi-centre clinical trial “PDSAFE”. Method: Search of four bibliographic databases using the terms “Parkinson*” and “Fall*” combined with each of the following; “Rehab*, Balanc*, Strength*, Strateg*and Exercis*” and a framework for narrative review was followed. A total of 3557 papers were identified, 416 were selected for review. The majority report the impact of rehabilitation on isolated fall risk factors. Twelve directly measure the impact on overall fall rate. Discussion: Results were used to construct a narrative review with conceptual discussion based on the “International Classification of Functioning”, leading to presentation of the “PDSAFE” intervention protocol. Conclusions: Evidence suggests training single, fall risk factors may not affect overall fall rate. Combining with behavioural and strategy training in a functional, personalised multi-dimensional model, addressing all components of the “International Classification of Functioning” is likely to provide a greater influence on falls reduction. “PDSAFE” is a multi-dimensional, physiotherapist delivered, individually tailored, progressive, home-based programme. It is designed with a strong evidence-based approach and illustrates a model for the clinical delivery of the conceptual theory discussed.Implications for Rehabilitation Parkinson’s disease demonstrates a spectrum of motor and non-motor symptoms, where falling is common and disabling. Current medical and surgical management have minimal impact on falls, rehabilitation of falls risk factors has strong evidence but the most appropriate intervention to reduce overall fall rate remains inconclusive. Addressing all components of the International Classification of Function in a multifactorial model when designing falls rehabilitation interventions may be more effective at reducing fall rates in people with Parkinson’s than treating isolated risk factors. The clinical model for falls rehabilitation in people with Parkinson’s should be multi-dimensional.

falls, International Classification of Function, Parkinson’s, rehabilitation
0963-8288
2596-2605
Hulbert, Sophia
eaded0e0-3abe-4972-8138-526baac5c472
Rochester, Lynn
ab1451e1-569c-43cd-ad84-987befff3f16
Nieuwboer, Alice
22396496-b367-4d0e-9a59-2c860c490c41
Goodwin, Vicki
8f287ed5-5276-463e-afe8-65480b33ee48
Fitton, Carolyn
6288734e-9b6e-470d-b420-33c16d65b879
Chivers-Seymour, Kim
04d3f834-c410-4710-ad99-f57e80ec8401
Ashburn, Ann
818b9ce8-f025-429e-9532-43ee4fd5f991
Hulbert, Sophia
eaded0e0-3abe-4972-8138-526baac5c472
Rochester, Lynn
ab1451e1-569c-43cd-ad84-987befff3f16
Nieuwboer, Alice
22396496-b367-4d0e-9a59-2c860c490c41
Goodwin, Vicki
8f287ed5-5276-463e-afe8-65480b33ee48
Fitton, Carolyn
6288734e-9b6e-470d-b420-33c16d65b879
Chivers-Seymour, Kim
04d3f834-c410-4710-ad99-f57e80ec8401
Ashburn, Ann
818b9ce8-f025-429e-9532-43ee4fd5f991

Hulbert, Sophia, Rochester, Lynn, Nieuwboer, Alice, Goodwin, Vicki, Fitton, Carolyn, Chivers-Seymour, Kim and Ashburn, Ann (2019) “Staying safe”–a narrative review of falls prevention in people with Parkinson’s–“PDSAFE”. Disability and Rehabilitation, 41 (21), 2596-2605. (doi:10.1080/09638288.2018.1471167).

Record type: Letter

Abstract

Background: Parkinson’s disease demonstrates a spectrum of motor and non-motor symptoms. Falling is common and disabling. Current medical management shows minimal impact to reduce falls or fall-related risk factors, such as deficits in gait, strength, and postural instability. Despite evidence supporting rehabilitation in reducing fall risk factors, the most appropriate intervention to reduce overall fall rate remains inconclusive. This article aims to 1) synthesise current evidence and conceptual models of falls rehabilitation in Parkinson’s in a narrative review; and based on this evidence, 2) introduce the treatment protocol used in the falls prevention and multi-centre clinical trial “PDSAFE”. Method: Search of four bibliographic databases using the terms “Parkinson*” and “Fall*” combined with each of the following; “Rehab*, Balanc*, Strength*, Strateg*and Exercis*” and a framework for narrative review was followed. A total of 3557 papers were identified, 416 were selected for review. The majority report the impact of rehabilitation on isolated fall risk factors. Twelve directly measure the impact on overall fall rate. Discussion: Results were used to construct a narrative review with conceptual discussion based on the “International Classification of Functioning”, leading to presentation of the “PDSAFE” intervention protocol. Conclusions: Evidence suggests training single, fall risk factors may not affect overall fall rate. Combining with behavioural and strategy training in a functional, personalised multi-dimensional model, addressing all components of the “International Classification of Functioning” is likely to provide a greater influence on falls reduction. “PDSAFE” is a multi-dimensional, physiotherapist delivered, individually tailored, progressive, home-based programme. It is designed with a strong evidence-based approach and illustrates a model for the clinical delivery of the conceptual theory discussed.Implications for Rehabilitation Parkinson’s disease demonstrates a spectrum of motor and non-motor symptoms, where falling is common and disabling. Current medical and surgical management have minimal impact on falls, rehabilitation of falls risk factors has strong evidence but the most appropriate intervention to reduce overall fall rate remains inconclusive. Addressing all components of the International Classification of Function in a multifactorial model when designing falls rehabilitation interventions may be more effective at reducing fall rates in people with Parkinson’s than treating isolated risk factors. The clinical model for falls rehabilitation in people with Parkinson’s should be multi-dimensional.

This record has no associated files available for download.

More information

Accepted/In Press date: 26 April 2018
e-pub ahead of print date: 18 May 2018
Published date: 9 October 2019
Keywords: falls, International Classification of Function, Parkinson’s, rehabilitation

Identifiers

Local EPrints ID: 434540
URI: http://eprints.soton.ac.uk/id/eprint/434540
ISSN: 0963-8288
PURE UUID: a51cc71c-26ee-459c-9f76-cf6f448631f1

Catalogue record

Date deposited: 01 Oct 2019 16:30
Last modified: 25 Nov 2021 19:45

Export record

Altmetrics

Contributors

Author: Sophia Hulbert
Author: Lynn Rochester
Author: Alice Nieuwboer
Author: Vicki Goodwin
Author: Carolyn Fitton
Author: Kim Chivers-Seymour
Author: Ann Ashburn

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×