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Open Access Highly Accessed Study protocol

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

Colleen G Canning1*, Cathie Sherrington2, Stephen R Lord3, Victor SC Fung4, Jacqueline CT Close3, Mark D Latt5, Kirsten Howard6, Natalie E Allen1, Sandra D O'Rourke1 and Susan M Murray1

Author Affiliations

1 Clinical and Rehabilitation Sciences Research Group, Faculty of Health Sciences, The University of Sydney, PO Box 170, Lidcombe, NSW 1825, Australia

2 Musculoskeletal Division, The George Institute for International Health, The University of Sydney, PO Box M201, Missenden Rd, Sydney, NSW 2050, Australia

3 Prince of Wales Medical Research Institute, PO Box 82, St Pauls, NSW 2031, Australia

4 Department of Neurology, Westmead Hospital, Westmead, NSW 2145, Australia

5 Department of General Geriatric and Rehabilitation Medicine, Royal Prince Alfred Hospital, KGV Buiding, Level 7, Missenden Rd, Camperdown, NSW 2030, Australia

6 School of Public Health, A27 Edward Ford Bld, The University of Sydney, Sydney, NSW 2006, Australia

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BMC Neurology 2009, 9:4  doi:10.1186/1471-2377-9-4

Published: 22 January 2009

Abstract

Background

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.

Methods/Design

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.

Discussion

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.

Trial registration

The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12608000303347).