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

ObjectiveTo explore the clinical reasoning of physiotherapists using PDSAFE; according to disease severity and their experiences treatment delivery in a large fall-prevention trial for people with Parkinson’s (PwP).DesignA descriptive study delivering PDSAFE. Semi-structured interviews explored therapists’ experiences.SettingA two-group, home-based, multi-centred, single-blinded, randomised controlled showed no overall effect on fall reduction between groups but demonstrated significant secondary relating benefits balance, falls efficacy near-falls all.ParticipantsPhysiotherapists background neurology older-person rehabilitation were trained PDSAFEInterventionA multi-dimensional, individually tailored progressive, home-based programme.ResultsFifteen contributed 2587 intervention sessions from PDSAFE six those took part interviews. The personalised was reflected range strategies exercises prescribed. Most commonly prescribed fall-avoidance ‘Avoiding tripping’, ‘Turning’ ‘Freezing Cues’ all possible combinations balance strength training within programme selected. PwP greater more likely have received less challenging strategies, strengthening than lower severity.Therapists considered focus events avoidance an improvement ‘impairment only’ treatment. presence cognitive deficits, co-morbidities dyskinesia most aspects intervention.ConclusionFalls management is complex compounded by progressive nature condition. Physiotherapists both delivered positively (248 words)The registration number ISRCTN 48152791