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Titre : | PDSAFE - a multi-dimensional model of falls-rehabilitation for people with Parkinsons. A mixed methods analysis of therapists delivery and experience (2021) |
Auteurs : | S. Hulbert ; K. Chivers-Seymour ; R. Summers ; S. Lamb ; V. Goodwin ; Lynn Rochester ; A. Nieuwboer ; A. Rowsell ; S. Ewing ; A. Ashburn |
Type de document : | Article |
Dans : | Physiotherapy (Vol. 110, 2021) |
Article en page(s) : | p. 77-84 |
Note générale : | https://doi.org/10.1016/j.physio.2020.08.006 |
Langues: | Anglais |
Descripteurs : |
HE Vinci Chutes accidentelles ; Kinésithérapie et physiothérapie ; Maladie de Parkinson ; Raisonnement clinique ; Réadaptation |
Résumé : |
Objective
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 Parkinsons (PwP). Design A descriptive study of delivering PDSAFE. Semi-structured interviews explored therapists experiences. Setting 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. Participants 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. Results 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. Conclusion Falls management for PwP is complex and compounded by the progressive nature of the condition. Physiotherapists both delivered and positively received PDSAFE. (248 words) |
Disponible en ligne : | Oui |
En ligne : | https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/science/article/pii/S0031940620304107#! |