Hulbert S, Chivers-Seymour K, Summers R, Lamb S, Goodwin V, Rochester L, Nieuwboer A, Rowsell A, Ewing S, Ashburn A
University of Exeter.
Health Sciences, University of Southampton.
Physiotherapy. 2021 Mar;110:77-84. doi: 10.1016/j.physio.2020.08.006. Epub 2020 Aug 30.
To explore the clinical reasoning of physiotherapists using PDSAFE; according to disease severity and their experiences of treatment delivery in a large fall-prevention trial for people with Parkinson's (PwP).
A descriptive study of delivering PDSAFE. Semi-structured interviews explored therapists' experiences.
A two-group, home-based, multi-centred, single-blinded, randomised controlled trial showed no overall effect on fall reduction between groups but demonstrated a significant secondary effect relating to disease severity with benefits to balance, falls efficacy and near-falls for all.
Physiotherapists with a background in neurology and older-person rehabilitation were trained in the delivery of PDSAFE INTERVENTION: A multi-dimensional, individually tailored and progressive, home-based programme.
Fifteen physiotherapists contributed to the 2587 intervention sessions from the PDSAFE trial and six of those physiotherapists took part in the interviews. The personalised intervention was reflected in the range of strategies and exercises prescribed. Most commonly prescribed fall-avoidance strategies were 'Avoiding tripping', 'Turning' and 'Freezing Cues' and all possible combinations of balance and strength training within the programme were selected. PwP with greater disease severity were more likely to have received less challenging strategies, balance and strengthening exercises than those with lower disease severity. Therapists considered the focus on fall events and fall avoidance strategies an improvement on 'impairment only' treatment. The presence of cognitive deficits, co-morbidities and dyskinesia were the most challenging aspects of delivering the intervention.
Falls management for PwP is complex and compounded by the progressive nature of the condition. Physiotherapists both delivered and positively received PDSAFE. (248 words) The trial registration number is ISRCTN 48152791.
探讨物理治疗师在帕金森病患者（PwP）大型预防跌倒试验中，依据疾病严重程度及治疗经验，运用PDSAFE进行临床推理的情况。
一项关于实施PDSAFE的描述性研究。通过半结构化访谈探究治疗师的经验。
一项两组、居家、多中心、单盲、随机对照试验表明，两组之间在减少跌倒方面无总体效果，但显示出与疾病严重程度相关的显著次要效果，对所有人的平衡、跌倒效能和接近跌倒情况有益。
具有神经学和老年康复背景的物理治疗师接受了PDSAFE实施培训。
一项多维、个性化定制且循序渐进的居家计划。
15名物理治疗师参与了PDSAFE试验的2587次干预课程，其中6名治疗师参与了访谈。个性化干预体现在所规定的策略和练习范围中。最常规定的防跌倒策略是“避免绊倒”“转身”和“冻结提示”，并且选择了该计划内所有可能的平衡和力量训练组合。与疾病严重程度较低的患者相比，疾病严重程度较高的PwP更有可能接受挑战性较小的策略、平衡和强化练习。治疗师认为，关注跌倒事件和防跌倒策略比“仅针对损伤”的治疗有所改进。认知缺陷、合并症和运动障碍的存在是实施干预最具挑战性的方面。
PwP的跌倒管理很复杂，且病情的进展性使其更加复杂。物理治疗师既实施了PDSAFE，也对其给予了积极评价。（248字）试验注册号为ISRCTN 48152791。
