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

To estimate the effect of a physiotherapist-delivered fall prevention programme for people with Parkinson's (PwP). 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. 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. 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. ISRCTN48152791.

Chivers Seymour K ，Pickering R ，Rochester L ，Roberts HC ，Ballinger C ，Hulbert S ，Kunkel D ，Marian IR ，Fitton C ，McIntosh E ，Goodwin VA ，Nieuwboer A ，Lamb SE ，Ashburn A ... -  《-》

Exercise- and strategy-based physiotherapy-delivered intervention for preventing repeat falls in people with Parkinson's: the PDSAFE RCT.

Ashburn A ，Pickering R ，McIntosh E ，Hulbert S ，Rochester L ，Roberts HC ，Nieuwboer A ，Kunkel D ，Goodwin VA ，Lamb SE ，Ballinger C ，Seymour KC ... -  《-》

A multi-centre, randomised controlled trial of the effectiveness of PDSAFE to prevent falls among people with Parkinson's: study protocol.

Goodwin VA ，Pickering R ，Ballinger C ，Roberts H ，McIntosh E ，Lamb S ，Nieuwboer A ，Rochester L ，Ashburn A ，PDSAFE Protocol Development Group ... -  《BMC Neurology》

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

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). A descriptive study of delivering PDSAFE. Semi-structured interviews explored therapists' experiences. 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. 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. 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. 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.

Hulbert S ，Chivers-Seymour K ，Summers R ，Lamb S ，Goodwin V ，Rochester L ，Nieuwboer A ，Rowsell A ，Ewing S ，Ashburn A ，PDSAFE Collaborative Group ... -  《-》

Cost-effectiveness of the PDSAFE personalised physiotherapy intervention for fall prevention in Parkinson's: an economic evaluation alongside a randomised controlled trial.

Xin Y ，Ashburn A ，Pickering RM ，Seymour KC ，Hulbert S ，Fitton C ，Kunkel D ，Marian I ，Roberts HC ，Lamb SE ，Goodwin VA ，Rochester L ，McIntosh E ，PDSAFE Collaborative group ... -  《BMC Neurology》