Objective: To explore the acceptability of a multidomain fall prevention program (Integrate) for people with Parkinson’s disease (PwP) and their care-partners, and factors that influenced the implementation and engagement with the program.

Background: Exercise can reduce falls in PwP but the fall rate remains high with exercise alone.1 The World Guidelines for Falls Prevention has a conditional recommendation for multidomain fall prevention intervention for PwP.2 Integrate, a multidomain fall prevention program consisting of exercise (for leg muscle strength, balance, and freezing of gait), home fall-hazard reduction (e.g., decluttering, bathroom rails), and training in safer mobility behaviors (e.g., slowing down and concentrating in risky situations), was designed and tested. People with moderate to advanced disease and recurrent falls completed the six-month, personalized program delivered by physical and occupational therapists with support from their care-partners.

Method: Qualitative, inductive thematic analyses of semi-structured interviews of 18 PwP and/or care-partners who underwent the Integrate program.

Results: Five themes were identified: 1) the importance of personalization, 2) a collaborative effort, 3) capacity building, 4) navigating fall risk with Parkinson’s is complex and 5) the ease (or not) of making changes. PwP and their care-partners valued the home-based and personalized program delivered by expert therapists that involved shared decision-making. They were more aware of their safety when mobilizing and developed better problem-solving skills. PwP were more engaged if they could see improvements and receiving ongoing support from therapists and care-partners. However, some PwP faced emotional and psychological barriers to engagement as they held fatalistic beliefs about disease progression and wanted to avoid appearing ‘disabled’. The reality of Parkinson’s disease motivated PwP to make changes but Parkinson’s-related impairments such as apathy and motor fluctuations hindered this.

Conclusion: PwP who fall recurrently, and their care-partners, found the Integrate program acceptable and were able to engage with it with guidance and support from therapists. A tailored program using a shared decision-making approach facilitated uptake of the program. Emotional and psychological barriers, such as fear of appearing ‘disabled’, should be addressed.

References: 1. Allen NE, Canning CG, Almeida LRS, et al. Interventions for preventing falls in Parkinson’s disease. Cochrane Database of Systematic Reviews. 2022;(6)doi:10.1002/14651858.CD011574.pub2

2. Montero-Odasso M, van der Velde N, Martin FC, et al. World guidelines for falls prevention and management for older adults: a global initiative. Age and Ageing. 2022;51(9)doi:10.1093/ageing/afac205

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-multidomain-fall-prevention-program-perspectives-of-people-with-parkinsons-disease-and-their-care-partners/