Parkinson’s fall prevention program gets high marks from most users
Patients, care partners say personalized strategies were key to improve safety
Most people with Parkinson’s disease who’d experienced recurring falls found a personalized, home-based fall prevention program in Australia helpful for improving their safety and confidence.
That’s according to a new assessment of the six-month program, dubbed Integrate, which was shown to reduce fall rates by nearly half among participants over six months of follow-up.
“Participants were motivated to engage with the programme to optimise mobility and reduce falls, despite challenges in forming new habits,” the researchers wrote, adding that both patients and their care partners “valued the shared decision-making approach of expert therapists and skills learnt to improve the safety of their mobility.”
Delivered by occupational and physiotherapists, most from the University of Sydney, the program combined tailored steps for reducing fall hazard risks at home with targeted exercises for increased mobility and safer mobility strategies.
This follow-up study found that increased awareness of fall risks and practical problem-solving skills encouraged long-term engagement among patients — motivating most participants to keep up with the strategies they learned. However, some individuals faced challenges such as apathy, motor fluctuations, or reluctance to appear as “disabled,” the researchers noted.
The study, “Acceptability of a programme for safer mobility (INTEGRATE): Perspectives of people with Parkinson’s disease and their care-partners,” was published in the journal Clinical Rehabilitation.
A progressive disease, Parkinson’s is marked by nerve cell death that in turn causes alterations in gait, or a person’s manner of walking, as well as slowed movement and other motor symptoms. Cognitive deficits and other nonmotor symptoms are also common.
Together, these features make people with Parkinson’s vulnerable to falling, which can incur both physical and financial costs and impact daily life.
“Fall prevention strategies that are effective across the disease spectrum are therefore urgently needed to reduce the fall-related healthcare needs of this growing population,” the researchers wrote.
After prevention program, fall rates dropped by nearly half
In an earlier study, the same team of researchers had developed and implemented the personalized intervention program Integrate for people with Parkinson’s experiencing recurrent falls.
The program highlighted strategies to make environments less hazardous and provided exercise and training for leg strength, balance, and freezing of gait. Occupational and physical therapists adjusted the strategies to meet the needs of each participant. During six months of follow-up, fall rates decreased by nearly half, data showed.
While the initial study focused on feasibility, this new study sought feedback from participants and care partners. The researchers interviewed 18 participants and/or their care partners and identified five key themes.
One theme was the importance of program personalization — including therapists’ flexibility and their ability to visit participants at home.
“Having someone come in to look at the home is useful because it mirrors the same activities and environment that I have to deal with every day,” one participant said.
It wasn’t like a doctor-patient thing, it was very much a ‘we’re in this together’ sort of thing.
Another theme from the interviews was the collaborative nature of the program. Pairing expert knowledge with participant involvement in decision-making was generally effective, the researchers found.
“It wasn’t like a doctor-patient thing, it was very much a ‘we’re in this together’ sort of thing,” a participant said. Alongside this, collaboration helped establish support systems and accountability.
However, when participants and their caregivers disagreed about the potential benefits of the program, the care partners were less able to encourage positive changes, the researchers found. For example, one participant expressed that he didn’t see the benefit of the program when the disease would continue to progress regardless, while his care partner thought the program would make him stronger.
Such discrepancies can lead to friction and reduce collaboration, the researchers noted.
“This study … underscores the importance of involving people with Parkinson’s disease and their care partners in shared problem solving and collaborative goal setting,” the team wrote.
Study highlights ‘the ease (or not) of making changes’
A third theme highlighted in the study was the ways that the program helped participants build capacity for safer mobility. Some participants felt the training made them more conscious of their movement, helping them avoid potential hazards.
“It’s increased my awareness of not getting into situations where I used to before and put myself in danger,” one participant said.
Similarly, some patients said the training helped them develop their own strategies to stay safe in new situations.
For others, however, it was difficult to maintain this awareness. Sometimes, the need or desire to do something prevented participants from implementing fall prevention strategies, the researchers noted.
This variability played into a fourth theme — that navigating the risk of falling was complicated. Indeed, in detailing the program’s results, the researchers noted “the ease (or not) of making changes,” which manifested in different ways.
Knowing that their condition would likely continue to deteriorate motivated some participants, but provided emotional or psychological barriers for others. Cognitive challenges could also make it more difficult to stick with plans, the researchers noted.
Social and environmental factors further complicated participants’ feelings about the program. For example, “safer mobility strategies were sometimes conspicuous, and one participant expressed this was a barrier to using her strategies in public, as a friend had commented that it looked ‘funny,’” the researchers wrote.
Therapist support helped participants embrace program
The final theme was that making changes to stay safer was often challenging, but generally not impossible. Some barriers were systemic, like the difficulties that people faced when trying to add ramps or rails to their homes. These changes could also be expensive, and not all participants could afford the modifications.
With finite physical and cognitive energy, some participants felt they couldn’t prioritize the program. Others felt that they developed habits throughout the program, reducing the energy they needed to invest in fall prevention.
“It’s subconscious, I do it all the time, I don’t even have to think about it,” one participant said.
Some patients welcomed the support of the therapists. While the reality of Parkinson’s motivated many to adapt, “empathy and support from therapists can help people adjust to changes as their needs evolve over time,” researchers wrote.
Together, participant and care partner feedback suggested that the program was “acceptable” to them, the team concluded. Future studies could investigate ways to address the barriers identified here, potentially strengthening interventions, the researchers suggested.
About the Author
