‘PDSAFE’ - a multi-dimensional model of falls-rehabilitation for people with Parkinson’s. A mixed methods analysis of therapists’ delivery and experience
Hulbert, S; Chivers-Seymour, K; Summers, R; et al.Lamb, S; Goodwin, V; Rochester, L; Nieuwboer, A; Rowsell, A; Ewing, S; Ashburn, A
Date: 30 August 2020
Journal
Physiotherapy
Publisher
Elsevier BV
Publisher DOI
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: ...
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.
Institute of Health Research
Collections of Former Colleges
Item views 0
Full item downloads 0
Except where otherwise noted, this item's licence is described as © 2020. This version is made available under the CC-BY-NC-ND 4.0 license: https://creativecommons.org/licenses/by-nc-nd/4.0/