Consensus-based clinical practice recommendations for the examination and management of falls in patients with Parkinson's disease

Marjolein A. van der Marck, Margit Ph C. Klok, Michael S. Okun, Nir Giladi, Marten Munneke, Bastiaan R. Bloem*, Kelly Arney, Nina M. Browner, Maggie Caunter, Heather J. Cianci, Becky Dunlop, Karla Eggert, Beth Fisher, Chris J. Hass, Christine Hunter, Mazen Jabre, Jeff Kraakevik, Kelly E. Lyons, Fenna Phibbs, Burton L. ScottLudy Shih, Eng King Tan, Louis Tan, Sara Varanese, Tiffini Voss, Ann Ashburn, Claire Ballinger, M. Tariq Bhatti, Jeff Hausdorff, Susanna Lindvall, Meg E. Morris, Alice Nieuwboer, Jason M. Schwalb, Stephanie Studenski, Brian H. Wood

*Corresponding author for this work

Research output: Contribution to journalShort surveypeer-review

Abstract

Falls in Parkinson's disease (PD) are common and frequently devastating. Falls prevention is an urgent priority, but there is no accepted program that specifically addresses the risk profile in PD. Therefore, we aimed to provide consensus-based clinical practice recommendations that systematically address potential fall risk factors in PD. We developed an overview of both generic (age-related) and PD-specific factors. For each factor, we specified: best method of ascertainment; disciplines that should be involved in assessment and treatment; and which interventions could be engaged. Using a web-based tool, we asked 27 clinically active professionals from multiple relevant disciplines to evaluate this overview. The revised version was subsequently reviewed by 12 experts. Risk factors and their associated interventions were included in the final set of recommendations when at least 66% of reviewing experts agreed. These recommendations included 31 risk factors. Nearly all required a multidisciplinary team approach, usually involving a neurologist and PD-nurse specialist. Finally, the expert panel proposed to first identify the specific fall type and to tailor screening and treatment accordingly. A routine evaluation of all risk factors remains reserved for high-risk patients without prior falls, or for patients with seemingly unexplained falls. In conclusion, this project produced a set of consensus-based clinical practice recommendations for the examination and management of falls in PD. These may be used in two ways: for pragmatic use in current clinical practice, pending further evidence; and as the active intervention in clinical trials, aiming to evaluate the effectiveness and cost-effectiveness of large scale implementation.

Original languageEnglish
Pages (from-to)360-369
Number of pages10
JournalParkinsonism and Related Disorders
Volume20
Issue number4
DOIs
StatePublished - Apr 2014
Externally publishedYes

Funding

FundersFunder number
Israel Science Office
Tel-Aviv Medical Centre
National Institutes of Health
Michael J. Fox Foundation for Parkinson's Research
National Park Foundation
National Parkinson Foundation
University of Florida Foundation
Parkinson Alliance
Frances C. and William P. Smallwood Foundation
European Commission
ZonMw016.076.352
Fonds NutsOhra
Tel Aviv University

    Keywords

    • Accidental falls
    • Clinical protocol
    • Parkinson's disease
    • Prevention

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