Falls Prevention in People with Parkinson’s: Why Multidomain Interventions Matter

Rethinking falls prevention in Parkinson’s

Falls prevention in people with Parkinson’s (PwP) remains one of the most complex challenges in neurorehabilitation. Exercise alone, while beneficial, does not always sufficiently address the multifactorial drivers of recurrent falls, particularly in those with more advanced disease, freezing of gait, or cognitive impairment.

A recent Australian feasibility study by Allen et al (2025) explored a personalised, multidomain OT/PT intervention aimed specifically at PwP with recurrent falls. The findings prompt an important shift in how clinicians approach and deliver falls rehab in Parkinson’s.

What did the study involve?

The INTEGRATE program delivered a 6-month home-based intervention, jointly led by occupational therapists and physiotherapists. It targeted safe mobility, rather than performance or speed, through three interacting domains:

Home fall hazard reduction (OT-led)
Individually tailored exercise (PT-led)
Safer mobility behaviour training (shared OT/PT responsibility)

The program included:

People with moderate–advanced Parkinson’s
Participants with mild–moderate cognitive impairment
Actively engaged care partners, where needed
Use of shared goal setting and habit-based strategies (e.g. mantras and visual cues)

Key Findings

Feasible, even in complex Parkinson’s

90% completion rate with no intervention-related adverse events
Good adherence to home modifications, exercise, and behavioural strategies
No increase in care-partner burden

This directly challenges the assumption that people with more advanced stages of Parkinson’s cannot safely engage in home-based falls prevention.

Safer mobility, not just “fitness”

81% of participants met or exceeded their safe mobility goals
Clinically meaningful improvement in the Short Physical Performance Battery
Improvements driven largely by balance, not speed

This reinforces an important principle in Parkinson’s falls rehab: Reducing falls is often about changing how someone moves, not their strength alone.

Falls reduced by ~50% post-intervention

While not powered as an efficacy RCT, fall rates were nearly halved during the 6-month follow-up period.

This is particularly notable given:

Exercise-alone programs can increase falls risk in advanced Parkinson’s
Most previous trials exclude people with cognitive impairment

Thought-provoking takeaways

Behaviour change may matter as much as exercise

Safer mobility behaviours e.g. “stop, think, be safe”, slowing turns and task sequencing were explicitly trained and reinforced until habitual.

This domain is often under-taught in physiotherapy-led falls rehab.

Cognition changes the intervention

Participants with lower MoCA scores required:

More care partner involvement
More clinician support
Simplified strategies

But they were not excluded. The question shifts from “Can they engage?” to “How do we adapt?”

OT–PT collaboration isn’t optional

Hazard management, behavioural adaptation, assistive technology, cueing strategies and task simplification sit squarely at the OT–PT interface.

Falls prevention in Parkinson’s is strongest when:

Roles overlap
Goals align
Messaging is consistent

Clinical Application

You don’t need a 6-month home trial to implement the principles. In outpatient or community rehab settings:

Combine exercise with explicit mobility safety coaching
Observe real-world movement behaviours, not just test performance
Use mantras, visual prompts, and routines
Address environmental risk, even from clinic-based assessments
Involve care partners early and intentionally

A simple clinical shift:

“What was happening just before you fell?” not “How is your balance today?”

Clinical Considerations:

The absence of a control group necessitates cautious interpretation of the findings, particularly given the high level of therapist expertise involved, which may limit immediate scalability in routine clinical settings.

Additionally, the behavioural habit measures utilised have not been validated in Parkinson’s populations, introducing uncertainty regarding their sensitivity and specificity. The intervention itself is relatively resource-intensive, requiring 8–12 visits, which may challenge feasibility in real-world service delivery. Furthermore, there is limited clarity regarding which intervention domain contributed most strongly to the observed outcomes.

Collectively, these limitations underscore the need for further work to clarify optimal dosage, evaluate cost-effectiveness, develop sustainable workforce training models, and undertake pragmatic randomised controlled trials to support broader translation into practice.

Clinical Reflection Questions

How explicitly do I teach safer mobility behaviours — separate from exercise — in my Parkinson’s clients?
Am I adapting interventions for cognitive load, or unintentionally penalising impairment?
How effectively do OT and PT goals align in my current falls rehab approach?