Prioritising fall prevention strategies in Parkinson's disease: A multi-method evaluation

ObjectiveFalls are a serious complication of Parkinson's disease, leading to functional decline, psychological distress, and substantial economic burden. Although multiple interventions have been proposed, structured quantitative guidance on prioritising fall-prevention strategies for clinical implementation in Parkinson's disease remains limited.DesignA multi-method study integrating a structured narrative review, expert consensus via a two-round Delphi process with 15 multidisciplinary Parkinson's disease experts, and multi-criteria decision-making using the Best-Worst Method to identify and quantitatively prioritise fall-prevention strategies for people with Parkinson's disease.SettingExpert-based consensus and decision-analysis study.ParticipantsFifteen multidisciplinary experts with clinical and research expertise in Parkinson's disease and neurorehabilitation.InterventionFall-prevention interventions identified through a structured narrative review and refined through a two-round Delphi process, followed by prioritisation using the Best-Worst Method.Main measuresRelative priority weights of intervention categories and sub-criteria derived using the Best-Worst Method based on expert judgements.ResultsThe Delphi process yielded three main criteria (exercise, dance-based interventions, and neuroscience-based interventions) and 14 sub-criteria. Best-Worst Method weighting showed that exercise had the highest priority (weight=0.49), followed by dance-based interventions (weight=0.32) and neuroscience-based interventions (weight=0.19). Within exercise, balance training and resistance strength training received the greatest weights, whereas Tai Chi and transcranial direct current stimulation received the highest expert-derived priority weights within the dance-based and neuroscience-based categories, respectively.ConclusionThis integrative framework provides an evidence-informed hierarchy of expert-derived priorities for fall-prevention interventions and may support clinical decision-making and programme design, while highlighting the need for further effectiveness and implementation research.