Turn-PD: A Co-designed Rehabilitation Programme To Improve Turning And Reduce Falls In Parkinson’s Disease

Background Falls are common in people with Parkinson's disease (PwP), resulting in reduced quality of life, increased hospital admission, and reduced life expectancy.

Falls commonly occur during turning in PwP, with falls whilst turning eight times more likely to result in hip fracture. As turning accounts for approximately 40% of steps during daily tasks, the risk of falling whilst turning is high. Turning is a complex mobility task, comprising both motor and cognitive skills and the interaction between the two.

Rehabilitation options to improve turning are limited and lack evidence base.

I will work to co-design and trial a rehabilitation intervention to improve turning, providing a novel treatment avenue for fall prevention in PwP.

Aims: 1) Understand how turning and cognitive problems lead to falls 2) Co-design and feasibility test an intervention for turning and falls alongside PwP and clinicians 3) Improve the way falls are measured in clinical trials 4) Undertake a pilot RCT (intervention v's standard care) in PwP 5) Form an implementation plan for a multi-site RCT Methods This project is composed of five work packages (WP): WP1 Develop and co-design (Months 1-14) First, a systematic review of the literature will be undertaken to determine associations between 1) turning and cognition, 2) turning and falls, and 3) falls and cognition.

Second, lived-experience workshops will be held with PwP and healthcare professionals to determine; 1) current problems with turning experienced by PwP, and 2) current effective strategies implemented by PwP and healthcare professionals. Findings from the review and workshops will be collated to design the intervention.

WP2 Measure (Months 2-70) A novel digital measurement tool for falls reporting will be co-designed alongside PwP to improve falls reporting in clinical trials. Beta-testing will be undertaken in 10 PwP for one month.

WP3 Feasibility: Implement, Test and Refine (Months 6-38) I will test the feasibility of delivering the proposed intervention developed in WP2.

PwP (n=14) will undertake the proposed intervention and qualitative feedback will be obtained from those delivering and receiving the intervention. WP4 Intervene: Pilot RCT (Months 40-70) The co-designed intervention will be trialled in a pilot RCT. PwP will be recruited and randomised into either intervention (n=35) or standard care (n=35).

Primary outcomes include recruitment, retention, adherence, adverse events, and acceptability.

Secondary outcomes (including objective turning measures and prospective falls) will be collected to determine the primary outcome measure for a future definitive trial.

WP5 Implement (Months 70-75) I will work with a steering group to develop the protocol (including identifying the primary outcome measure and calculating sample size) for a larger definitive trial.

Anticipated Impact and Dissemination Scientific community: Journal publications, presentations at national and international conferences and social media platforms.

Healthcare professionals: Collaboration with Parkinson's Excellence Network, local dissemination via the Parkinson's Research Interest Group Northeast and North Cumbria (PD NEC-RIG). Patients and the public: Participant newsletters, patient blogs and via the PD NEC-RIG website and events. An infographic will be designed to raise awareness of falls related to turning.