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‘PDSAFE’ - a multi-dimensional model of falls-rehabilitation for people with Parkinson’s. A mixed methods analysis of therapists’ delivery and experience

‘PDSAFE’ - a multi-dimensional model of falls-rehabilitation for people with Parkinson’s. A mixed methods analysis of therapists’ delivery and experience
‘PDSAFE’ - a multi-dimensional model of falls-rehabilitation for people with Parkinson’s. A mixed methods analysis of therapists’ delivery and experience

Objective: To explore the clinical reasoning of physiotherapists using PDSAFE; according to disease severity and their experiences of treatment delivery in a large fall-prevention trial for people with Parkinson's (PwP). Design: A descriptive study of delivering PDSAFE. Semi-structured interviews explored therapists’ experiences. Setting: A two-group, home-based, multi-centred, single-blinded, randomised controlled trial showed no overall effect on fall reduction between groups but demonstrated a significant secondary effect relating to disease severity with benefits to balance, falls efficacy and near-falls for all. Participants: Physiotherapists with a background in neurology and older-person rehabilitation were trained in the delivery of PDSAFE Intervention: A multi-dimensional, individually tailored and progressive, home-based programme. Results: Fifteen physiotherapists contributed to the 2587 intervention sessions from the PDSAFE trial and six of those physiotherapists took part in the interviews. The personalised intervention was reflected in the range of strategies and exercises prescribed. Most commonly prescribed fall-avoidance strategies were ‘Avoiding tripping’, ‘Turning’ and ‘Freezing Cues’ and all possible combinations of balance and strength training within the programme were selected. PwP with greater disease severity were more likely to have received less challenging strategies, balance and strengthening exercises than those with lower disease severity. Therapists considered the focus on fall events and fall avoidance strategies an improvement on ‘impairment only’ treatment. The presence of cognitive deficits, co-morbidities and dyskinesia were the most challenging aspects of delivering the intervention. Conclusion: Falls management for PwP is complex and compounded by the progressive nature of the condition. Physiotherapists both delivered and positively received PDSAFE. (248 words) The trial registration number is ISRCTN 48152791

Clinical reasoning, Fall, Parkinson's, Physiotherapy, Rehabilitation
0031-9406
Hulbert, S
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Chivers-seymour, K
69d77553-6dd6-461b-a174-b604ccf44ec2
Summers, R
811d6b74-d5f4-4e92-a507-9bdca978fda5
Lamb, S
c9d95012-21c5-48db-8b36-b6da3fb011b4
Goodwin, V
8f287ed5-5276-463e-afe8-65480b33ee48
Rochester, L
ced8b830-6dd8-4d41-95bd-2dd451d92669
Nieuwboer, A
4853bbe0-1221-4fe4-a901-e61749589207
Rowsell, A
058f3917-b556-4eef-a393-4c025a3c4ccb
Ewing, S
326656df-c0f0-44a1-b64f-8fe9578ca18a
Ashburn, A
818b9ce8-f025-429e-9532-43ee4fd5f991
Hulbert, S
eaded0e0-3abe-4972-8138-526baac5c472
Chivers-seymour, K
69d77553-6dd6-461b-a174-b604ccf44ec2
Summers, R
811d6b74-d5f4-4e92-a507-9bdca978fda5
Lamb, S
c9d95012-21c5-48db-8b36-b6da3fb011b4
Goodwin, V
8f287ed5-5276-463e-afe8-65480b33ee48
Rochester, L
ced8b830-6dd8-4d41-95bd-2dd451d92669
Nieuwboer, A
4853bbe0-1221-4fe4-a901-e61749589207
Rowsell, A
058f3917-b556-4eef-a393-4c025a3c4ccb
Ewing, S
326656df-c0f0-44a1-b64f-8fe9578ca18a
Ashburn, A
818b9ce8-f025-429e-9532-43ee4fd5f991

Hulbert, S, Chivers-seymour, K, Summers, R, Lamb, S, Goodwin, V, Rochester, L, Nieuwboer, A, Rowsell, A, Ewing, S and Ashburn, A (2020) ‘PDSAFE’ - a multi-dimensional model of falls-rehabilitation for people with Parkinson’s. A mixed methods analysis of therapists’ delivery and experience. Physiotherapy. (doi:10.1016/j.physio.2020.08.006).

Record type: Article

Abstract

Objective: To explore the clinical reasoning of physiotherapists using PDSAFE; according to disease severity and their experiences of treatment delivery in a large fall-prevention trial for people with Parkinson's (PwP). Design: A descriptive study of delivering PDSAFE. Semi-structured interviews explored therapists’ experiences. Setting: A two-group, home-based, multi-centred, single-blinded, randomised controlled trial showed no overall effect on fall reduction between groups but demonstrated a significant secondary effect relating to disease severity with benefits to balance, falls efficacy and near-falls for all. Participants: Physiotherapists with a background in neurology and older-person rehabilitation were trained in the delivery of PDSAFE Intervention: A multi-dimensional, individually tailored and progressive, home-based programme. Results: Fifteen physiotherapists contributed to the 2587 intervention sessions from the PDSAFE trial and six of those physiotherapists took part in the interviews. The personalised intervention was reflected in the range of strategies and exercises prescribed. Most commonly prescribed fall-avoidance strategies were ‘Avoiding tripping’, ‘Turning’ and ‘Freezing Cues’ and all possible combinations of balance and strength training within the programme were selected. PwP with greater disease severity were more likely to have received less challenging strategies, balance and strengthening exercises than those with lower disease severity. Therapists considered the focus on fall events and fall avoidance strategies an improvement on ‘impairment only’ treatment. The presence of cognitive deficits, co-morbidities and dyskinesia were the most challenging aspects of delivering the intervention. Conclusion: Falls management for PwP is complex and compounded by the progressive nature of the condition. Physiotherapists both delivered and positively received PDSAFE. (248 words) The trial registration number is ISRCTN 48152791

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e-pub ahead of print date: 30 August 2020
Keywords: Clinical reasoning, Fall, Parkinson's, Physiotherapy, Rehabilitation

Identifiers

Local EPrints ID: 445843
URI: http://eprints.soton.ac.uk/id/eprint/445843
ISSN: 0031-9406
PURE UUID: 51d0fdb5-b6c1-4993-bd8e-d71adb8a1e0e
ORCID for R Summers: ORCID iD orcid.org/0000-0001-9060-0584
ORCID for S Ewing: ORCID iD orcid.org/0000-0001-7214-4917

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Date deposited: 08 Jan 2021 17:33
Last modified: 08 Jan 2021 17:33

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Contributors

Author: S Hulbert
Author: K Chivers-seymour
Author: R Summers ORCID iD
Author: S Lamb
Author: V Goodwin
Author: L Rochester
Author: A Nieuwboer
Author: A Rowsell
Author: S Ewing ORCID iD
Author: A Ashburn

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