Objective: To determine the feasibility and preliminary efficacy of a novel virtually-delivered protocol targeting extrinsic environmental fall risk factors in the homes of persons with Parkinson’s Disease (PwPs).

Background: Prospective studies have shown that the majority of falls in PwPs occur at home.  Beyond just access to care, telehealth empowers providers with a lens into a patient’s everyday life and home environment, making it a particularly suitable vehicle to address fall prevention.

Method: We recruited PwPs at risk for falls and their carepartners to a novel four-month virtual home safety program. A neurologic certified physical therapist conducted four monthly televisits per dyad that involved virtual home tours to identify and mitigate extrinsic environmental fall risk factors.  A PI-developed comprehensive guide, the modified Home Safety Self-Assessment Tool (mHSSAT), was utilized to operationalize home tours, provide solutions for home modification, and generate objective pre- and post-“total hazard scores.” The Goal Attainment Scale (GAS) was implemented to assess progress towards three individualized home-safety goals established at baseline.

Results: Twenty-three dyads completed all protocol-driven televisits with no adverse events and minimal connectivity issues, demonstrating high feasibility. The intervention led to a median 55.6% (IQR 36.4-84.6%) reduction in extrinsic home hazards as measure by the “total hazard scores” of the mHSSAT. While objective measures (NFOG, FES-I, SES, PDQ-39, Godin) did not show statistically significant changes, some trended toward improvement. Mean freezing severity (NFOG) decreased (24 → 21) and PDQ-39 Mobility (39.87 → 38.68) and ADL (31.25 → 30.11) showed improvement. Significant improvement was seen with CGI/PGI ratings, with therapists, patients, and carepartners all perceiving improvements in intrinsic behavioral and extrinsic environmental fall risk.  Composite GAS scores improved significantly (p < 0.0001).

Conclusion: This pilot study revealed that the mHSSAT virtual program may be a useful tool to reduce environmental fall risk in PwPs’ homes.  Improvements seen in NFOG and PDQ-39 Mobility and ADL are promising and a future larger randomized study with blinded assessments is planned to further evaluate efficacy.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-novel-virtual-home-safety-fall-prevention-program-for-parkinsons-disease/