Consensus-based clinical practice recommendations for the examination and management of falls in patients with Parkinson's disease.
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.
Radboud university medical center, Nijmegen Centre for Evidence Based Practice, Department of Neurology, Nijmegen, The Netherlands.
Marjolein A
MA
van der Marck
Radboud university medical center, Nijmegen Centre for Evidence Based Practice, Department of Neurology, Nijmegen, The Netherlands.
Margit Ph C
MP
Klok
University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, FL, USA.
Michael S
MS
Okun
Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Nir
N
Giladi
Radboud university medical center, Nijmegen Centre for Evidence Based Practice, Department of Neurology, Nijmegen, The Netherlands; Radboud university medical center, Nijmegen Centre for Evidence Based Practice, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands.
Marten
M
Munneke
Radboud university medical center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Nijmegen, The Netherlands. Electronic address: Bas.Bloem@radboudumc.nl.
Bastiaan R
BR
Bloem
D000058:Accidental Falls / Q000517:prevention & control*; D006801:Humans; D010300:Parkinson Disease / Q000150:complications*
Accidental falls; Clinical protocol; Parkinson's disease; Prevention