Acceptability of a programme for safer mobility (INTEGRATE): Perspectives of people with Parkinson's disease and their care-partners

Abstract

ObjectiveThis study aimed to explore the acceptability and factors that influenced implementation of a multidomain, home-based fall prevention programme (Integrate) for people with Parkinson's disease who fall recurrently, and their care-partners.DesignQualitative, inductive thematic analysis of semi-structured interviews.SettingHomes of Integrate participants in Sydney, Australia.ParticipantsEighteen interviews with people with Parkinson's disease and/or their care-partner who were purposively sampled after completing Integrate.InterventionIntegrate was delivered by occupational therapists and physiotherapists and included personally tailored home fall-hazard reduction, exercise (leg muscle strength, balance and freezing of gait) and safer mobility strategies delivered over 6 months.ResultsFive themes were identified: (a) the importance of personalisation, (b) a collaborative effort, (c) capacity building, (d) navigating fall risk with Parkinson's is complex and (e) the ease (or not) of making changes. Participants and their care-partners appreciated the personalised, home-based programme that involved shared decision-making and was delivered by expert therapists. They developed increased safety awareness and problem-solving skills. Making improvements, receiving ongoing support from therapists and care-partners and making change easier promoted sustained engagement. However, some participants faced emotional and psychological barriers to engagement including fatalistic beliefs about disease progression and a desire to avoid appearing 'disabled'. The reality of Parkinson's disease motivated participants to make changes but Parkinson's-related impairments such as apathy and motor fluctuations hindered this.ConclusionsPeople with Parkinson's disease who are recurrent fallers, and their care-partners, found the Integrate programme acceptable and were able to engage with it with guidance and support from therapists.

Keywords: Parkinson's disease; falls; mobility; rehabilitation.