Protocol for a home-based integrated physical therapy program to reduce falls and improve mobility in people with Parkinson’s disease

Background The high incidence of falls associated with Parkinson’s disease (PD) increases the risk of injuries and immobility and compromises quality of life. Although falls education and strengthening programs have shown some benefit in healthy older people, the ability of physical therapy interventions in home settings to reduce falls and improve mobility in people with Parkinson’s has not been convincingly demonstrated.Methods/design 180 community living people with PD will be randomly allocated to receive either a home-based integrated rehabilitation program (progressive resistance strength training, movement strategy training and falls education) or a home-based life skills program (control intervention). Both programs comprise one hour of treatment and one hour of structured homework per week over six weeks of home therapy. Blinded assessments occurring before therapy commences, the week after completion of therapy and 12 months following intervention will establish both the immediate and long-term benefits of home-based rehabilitation. The number of falls, number of repeat falls, falls rate and time to first fall will be the primary measures used to quantify outcome. The economic costs associated with injurious falls, and the costs of running the integrated rehabilitation program from a health system perspective will be established. The effects of intervention on motor and global disability and on quality of life will also be examined. Discussion This study will provide new evidence on the outcomes and cost effectiveness of home-based movement rehabilitation programs for people living with PD

Exercise therapy for prevention of falls in people with Parkinson's disease: A protocol for a randomised controlled trial and economic evaluation

<p>Abstract</p> <p>Background</p> <p>People with Parkinson's disease are twice as likely to be recurrent fallers compared to other older people. As these falls have devastating consequences, there is an urgent need to identify and test innovative interventions with the potential to reduce falls in people with Parkinson's disease. The main objective of this randomised controlled trial is to determine whether fall rates can be reduced in people with Parkinson's disease using exercise targeting three potentially remediable risk factors for falls (reduced balance, reduced leg muscle strength and freezing of gait). In addition we will establish the cost effectiveness of the exercise program from the health provider's perspective.</p> <p>Methods/Design</p> <p>230 community-dwelling participants with idiopathic Parkinson's disease will be recruited. Eligible participants will also have a history of falls or be identified as being at risk of falls on assessment. Participants will be randomly allocated to a usual-care control group or an intervention group which will undertake weight-bearing balance and strengthening exercises and use cueing strategies to address freezing of gait. The intervention group will choose between the home-based or support group-based mode of the program. Participants in both groups will receive standardized falls prevention advice. The primary outcome measure will be fall rates. Participants will record falls and medical interventions in a diary for the duration of the 6-month intervention period. Secondary measures include the Parkinson's Disease Falls Risk Score, maximal leg muscle strength, standing balance, the Short Physical Performance Battery, freezing of gait, health and well being, habitual physical activity and positive and negative affect schedule.</p> <p>Discussion</p> <p>No adequately powered studies have investigated exercise interventions aimed at reducing falls in people with Parkinson's disease. This trial will determine the effectiveness of the exercise intervention in reducing falls and its cost effectiveness. This pragmatic program, if found to be effective, has the potential to be implemented within existing community services.</p> <p>Trial registration</p> <p>The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12608000303347).</p

The relationship of vitamin D with bone mineral density in Parkinson's disease patients

Serdaroglu Beyazal, Munevver/0000-0001-5903-5708WOS: 000369751600005Objectives: the purposes of the present study were to evaluate bone mineral density (BMD) and vitamin D status in Parkinson's disease (PD) and to identify the correlation of vitamin D with BMD and disease related parameters. Methods: Fifty-two patients with PD and 39 controls were recruited in study. Hoehn and Yahr (HY) staging scale, parts II and III of the Unified Parkinson's Disease Rating Scale (UPDRS) were used to assess disease stage, daily living activities, and motor activity, respectively. BMD of lumbar spine and femoral neck were assessed by dual energy X-ray absorptiometry. Serum 25-hydroxyvitamin D (25OHD) levels were measured. Results: Seventeen patients (32.7%) were osteoporotic and 22 (42.3%) osteopenic. Female and male PD patients had significantly lower T scores and BMD values at femoral neck, whereas only female patients showed significant differences in T scores and BMD values at lumbar spine compared to controls. the mean 25OHD levels were significantly lower in PD patients compared with controls. 25OHD levels showed a positive correlation with T scores and BMD values of lumbar spine and femoral neck and a negative correlation with UPDRS part II, UPDRS part III, and HY stage. in partial correlation analysis performed to adjust disease duration, 25OHD levels were also correlated with lumbar and femoral neck BMD values, femoral neck T scores, but not with other studied parameters. Conclusions: This study demonstrated that PD patients had lower 25OHD levels and decreased BMD values compared to controls and detected significant association of 25OHD levels with BMD values. (C) 2015 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved