An exercise intervention to prevent falls in people with Parkinson's disease: a pragmatic randomised controlled trial

Abstract

Objectives To compare the effectiveness of an exercise programme with usual care in people with Parkinson's disease (PD) who have a history of falls. Design Pragmatic randomised controlled trial. Setting Recruitment was from three primary and four secondary care organisations, and PD support groups in South West England. The intervention was delivered in community settings. Participants People with PD, with a history of two or more falls in the previous year, who were able to mobilise independently. Intervention 10 week, physiotherapy led, group delivered strength and balance training programme with supplementary home exercises (intervention) or usual care (control). Main outcome measure Number of falls during the (a) 10 week intervention period and (b) the 10 week followup period. Results 130 people were recruited and randomised (64 to the intervention; 66 to usual care). Seven participants (5.4%) did not complete the study. The incidence rate ratio for falls was 0.68 (95% CI 0.43 to 1.07, p¼0.10) during the intervention period and 0.74 (95% CI 0.41 to 1.33, p¼0.31) during the follow-up period. Statistically significant between group differences were observed in Berg balance, Falls Efficacy Scale-International scores and recreational physical activity levels. Conclusions The study did not demonstrate a statistically significant between group difference in falls although the difference could be considered clinically significant. However, a type 2 error cannot be ruled out. The findings from this trial add to the evidence base for physiotherapy and exercise in the management of people with PD. Trial registration ISRCTN50793425.

Effects of Alexander-Based Corrective Techniques on Forward Flexed Posture, Risk of Fall, and Fear of Falling in Idiopathic Parkinson’s Disease

“…Some other researchers, who reported similar findings to our study, used different timebased protocols of ABCTs (44). For instance, Stallibrass et al (2002) using ABCT (44), Goodwin (2011) using an exercise intervention (45), and Sedaghati (2016) (31) using a selective corrective exercise showed improvements in trunk posture alignment. However, Sparrow using 3 months of active balance exercises (46) and Khalil using a homeexercise and walking program (47) revealed no significant differences in posture alignment.…”

“…In general, as the central control of efferents in PD was compromised in our study (56), PD patients might benefit from ABCT. Considering the scarcity of recent studies on the effects of rehabilitation programs on reducing falls in PD patients (57), only few researchers have evaluated falls as a mixed outcome in combination with other factors (e.g., balance, fall risk, and FOF) (45,46,(57)(58)(59)(60).…”

Possibilities of non-drug treatment for Parkinson’s disease

“…Подчеркнем, что исследование касается не просто пациентов с БП, но больных с пониженной мо-торной активностью. В отношении частоты падений су-щественного эффекта ЛФК не оказывает [35,38]. Эрготе-рапия оказывает положительное влияние на качество жизни (оценка по PDQ-39), дневную активность (оценка по NEADL) [15].…”

Evaluation and delivery of ambulatory rehabilitation for people with Parkinson's disease

“…3,28,46 However, individual therapy sessions have also been shown to be effective 50 and may allow the therapy to be more specific and tailored to personal goals. 28 While many rehabilitation interventions for people with PD utilize group therapy sessions, 3,46,47,55,56 or a combination of group and individual treatments, 11,57 to our knowledge there are no studies that specifically examine the efficacy of group versus individual therapy in this patient population.…”

“…3,15,28,30,37,40,47,56,63 There are also a number of recent studies that have examined the efficacy of specific therapy techniques, including some novel approaches. 36,37,55,62,[64][65][66][67] These are summarized in Table 2.…”