Falls 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.
Design
A 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.
Setting
Expert-based consensus and decision-analysis study.
Participants
Fifteen multidisciplinary experts with clinical and research expertise in Parkinson's disease and neurorehabilitation.
Intervention
Fall-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 measures
Relative priority weights of intervention categories and sub-criteria derived using the Best–Worst Method based on expert judgements.
Results
The 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.
Conclusion
This 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.
SajinVGoodallMMacerolloA. Camptocormia in Parkinson’s disease: state of the art and future directions. J Neurol2025; 272: 638.
2.
WangRLianTHeM, et al.Clinical features and neurobiochemical mechanisms of olfactory dysfunction in patients with Parkinson disease. J Neurol2024; 271: 1959–1972.
3.
PringsheimTJetteNFrolkisA,et al.The prevalence of Parkinson’s disease: a systematic review and meta-analysis. Mov Disord2014; 29: 1583–1590.
4.
SuDCuiYHeC, et al.Projections for prevalence of Parkinson’s disease and its driving factors in 195 countries and territories to 2050: modelling study of global burden of disease study 2021. Br Med J2025; 388: e080952.
5.
LonghurstJKHooymanALandersMR, et al.Discordance between balance ability and perception is associated with falls in Parkinson’s disease: a coordinated analysis. Neurorehabil Neural Repair2025; 39: 114–125.
6.
CuiWLiDYueL,et al.The effects of exercise dose on patients with Parkinson’s disease: a systematic review and meta-analysis of randomized controlled trials. J Neurol2023; 270: 5327–5343.
7.
WallénMBHagströmerMConradssonD, et al.Long-term effects of highly challenging balance training in Parkinson’s disease—a randomized controlled trial. Clin Rehabil2018; 32: 1520–1529.
8.
BloemBRHausdorffJMVisserJE,et al.Falls and freezing of gait in Parkinson’s disease: a review of two interconnected, episodic phenomena. Mov Disorders: Off J Mov Disorder Soc2004; 19: 871–884.
9.
KonczakJCorcosDMHorakF, et al.Proprioception and motor control in Parkinson’s disease. J Mot Behav2009; 41: 543–552.
10.
ParmeraJBWrigleySCullinanePW, et al.The impact of cognitive impairment and Alzheimer’s disease neuropathological changes on gait, freezing and falls in Parkinson’s disease. Parkinsonism Relat Disord2025; 135: 107826.
11.
Van BladelAHerssensNBoucheK, et al.Proportion of falls reported in persons with Parkinson’s disease: a meta-analysis. Clin Rehabil2023; 37: 1260–1277.
12.
LattMDLordSRMorrisJG,et al.Clinical and physiological assessments for elucidating falls risk in Parkinson’s disease. Movt Disorders: Off J Mov Disorder Soc2009; 24: 1280–1289.
13.
PickeringRMGrimbergenYARigneyU, et al.A meta-analysis of six prospective studies of falling in Parkinson’s disease. Mov Disord2007; 22: 1892–1900.
14.
AhmadinejadBBahramianFMousaviSA,et al.Identify the most effective elderly preventive falling interventions using MCDM technique. Phys Occup Ther Geriatr2024; 42: 53–69.
15.
AllenNEDarmaliAKochC, et al.Acceptability of a programme for safer mobility (INTEGRATE): perspectives of people with Parkinson’s disease and their care-partners. Clin Rehabil2025; 39: 1378–1389.
16.
ZijlstraGRVan HaastregtJCVan RossumE, et al.Interventions to reduce fear of falling in community-living older people: a systematic review. J Am Geriatr Soc2007; 55: 603–615.
17.
KowalSLDallTMChakrabartiR, et al.The current and projected economic burden of Parkinson’s disease in the United States. Mov Disord2013; 28: 311–318.
18.
MorrisMETaylorNFWattsJJ, et al.A home program of strength training, movement strategy training and education did not prevent falls in people with Parkinson’s disease: a randomised trial. J Physiother2017; 63: 94–100.
19.
LawNYLiJXZhuQ, et al.Effects of a Biomechanical-based Tai Chi Program on Gait and Posture in People With Parkinson’s Disease: Study Protocol for a Randomized Controlled Trial. 2021.
20.
Rossi-IzquierdoMErnstASoto-VarelaA, et al.Vibrotactile neurofeedback balance training in patients with Parkinson’s disease: reducing the number of falls. Gait Posture2013; 37: 195–200.
21.
GoodwinVARichardsSHHenleyW, et al.An exercise intervention to prevent falls in people with Parkinson’s disease: a pragmatic randomised controlled trial. J Neurol Neurosurg Psychiatry2011; 82: 1232–1238.
22.
NascimentoLRdo CarmoWAde OliveiraGP, et al.Transcranial direct current stimulation provides no clinically important benefits over walking training for improving walking in Parkinson’s disease: a systematic review. J Physiother2021; 67: 190–196.
23.
ZhangTYHuYNieZY, et al.Effects of tai chi and multimodal exercise training on movement and balance function in mild to moderate idiopathic Parkinson disease. Am J Phys Med Rehabil2015; 94: 921–929.
24.
Chamberlain-CarterJJacksonJ. Does resistance training reduce falls and improve quality of life in people with Parkinson’s disease using strength training exercise programmes?Phys Ther Rev2021; 26: 1–9.
25.
WuMTangQWangL, et al.Efficacy of traditional Chinese exercise in improving gait and balance in cases of Parkinson’s disease: a systematic review and meta-analysis. Front Aging Neurosci2022; 14: 927315.
26.
HołajJChalimoniukM. The impact of dance on balance and posture control in Parkinson’s disease–a systematic review. Physiotherapy Rev2022; 26: 5–17.
27.
NguyenTXDMaiPTChangYJ,et al.Effects of transcranial direct current stimulation alone and in combination with rehabilitation therapies on gait and balance among individuals with Parkinson’s disease: a systematic review and meta-analysis. J Neuroeng Rehabil2024; 21: 27.
28.
Barkhordari AhmadiFEsmaeeliBShariat MoghaniS, et al.literature review of group decision-making: The case study of Delphi method.Med Educ Bull2023; 4: 824–833.
29.
RezaeiJ. Best-worst multi-criteria decision-making method: some properties and a linear model. Omega (Westport)2016; 64: 126–130.
30.
RezaeiJNispelingTSarkisJ,et al.A supplier selection life cycle approach integrating traditional and environmental criteria using the best worst method. J Cleaner Prod2016; 135: 577–588.
31.
SalimiNRezaeiJ. Evaluating firms’ R&D performance using best worst method. Eval Program Plann2018; 66: 147–155.
32.
GuptaHBaruaMK. A framework to overcome barriers to green innovation in SMEs using BWM and fuzzy TOPSIS. Sci Total Environ2018; 633: 122–139.
33.
SamuelA. Decision-making under uncertainty: Prioritizing interventions for adolescent nutrition using Bwm. BEST-WORST METHOD.
34.
XuRHShiLShiZ, et al.Investigating individuals’ preferences in determining the functions of smartphone apps for fighting pandemics: best-worst scaling survey study. J Med Internet Res2023; 25: e48308.
35.
MohammadiMRezaeiJ. Bayesian best-worst method: a probabilistic group decision making model. Omega (Westport)2020; 96: 102075.
36.
BahramianFAbolfazSMousaviA, et al.Dance-based interventions on balance and falls in the elderly in order to health promotion: a literature review. J Public Health Dev2023; 21: 257–271.
37.
DaiSYuanHWangJ, et al.Effects of aquatic exercise on the improvement of lower-extremity motor function and quality of life in patients with Parkinson’s disease: a meta-analysis. Front Physiol2023; 14: 1066718.
38.
Monleón GuinotSSan Martín ValenzuelaCAranda AsensiV, et al.Functional balance training in people with Parkinson’s disease: a protocol of balanceHOME randomized control trial with crossover. Front Aging Neurosci2023; 15: 1137360.
39.
MartinTWeatherallMAndersonTJ,et al.A randomized controlled feasibility trial of a specific cueing program for falls management in persons with Parkinson disease and freezing of gait. J Neurol Phys Ther2015; 39: 179–184.
40.
EmigMGeorgeTZhangJK,et al.The role of exercise in Parkinson’s disease. J Geriatr Psychiatry Neurol2021; 34: 321–330.
41.
López-LiriaRVega-TiradoSValverde-MartínezMÁ, et al.Efficacy of specific trunk exercises in the balance dysfunction of patients with Parkinson’s disease: a systematic review and meta-analysis. Sensors2023; 23: 1817.
42.
Mayoral-MorenoARodríguez-SantosLChimpén-LópezCA, et al.Effects of square stepping exercise on physical, cognitive and psychosocial fitness in people with Parkinson’s disease. Psychiatric Quarterly2025; 97: 1–26.
43.
Docu AxeleradAStroeAZMujaLF, et al.Benefits of tango therapy in alleviating the motor and non-motor symptoms of Parkinson’s disease patients—a narrative review. Brain Sci2022; 12: 448.
44.
ArasBSeyyarGKFidanO,et al.The effect of Tai Chi on functional mobility, balance and falls in Parkinson’s disease: a systematic review and meta-analysis of systematic reviews. Explore2022; 18: 402–410.
45.
BhondeI. Effect of yoga therapy on kinesiophobia. Physical function and fall prevention in Parkinson’s disease. J Sports Phy Educ Stud2023; 3: 51–53.
46.
ÇobanFBelgen KaygısızBSelcukF. Effect of clinical pilates training on balance and postural control in patients with Parkinson’s disease: a randomized controlled trial. J Comp Eff Res2021; 10: 1373–1383.
47.
ShahrbanianSHashemiAHemayattalabR. The comparison of the effects of physical activity and neurofeedback training on postural stability and risk of fall in elderly women: a single-blind randomized controlled trial. Physiother Theory Pract2021; 37: 271–278.
48.
MirelmanAHermanTNicolaiS, et al.Audio-biofeedback training for posture and balance in patients with Parkinson’s disease. J Neuroeng Rehabil2011; 8: 35.
49.
ShenXWong-YuISMakMK. Effects of exercise on falls, balance, and gait ability in Parkinson’s disease: a meta-analysis. Neurorehabil Neural Repair2016; 30: 512–527.
50.
SmaniaNCoratoETinazziM, et al.Effect of balance training on postural instability in patients with idiopathic Parkinson’s disease. Neurorehabil Neural Repair2010; 24: 826–834.
51.
KhallafMJaberHAlameriM, et al.Effect of vestibular-oriented balance training on postural control and risk of fall in patients with Parkinson’s disease. Neurol Res Int2025; 2025: 6846267.
52.
de LimaKPda SilvaCNde SeixasNF, et al.Effect of resistance training on balance and postural control in people with Parkinson’s: a systematic review. Revista Científica de la Sociedad de Enfermería Neurológica (English ed)2022; 56: 18–28.
53.
ZhaoliMXiaoZBeibeiL, et al.Meta-analysis: the effect of muscle strength training on walking ability of patients with Parkinson’s disease. Rehabil Sci2021; 6: 1–9.
54.
IntzandtB.Can a Power Training Program Reduce Fall Risk Factors in Parkinson’s Disease?2016.
55.
CanningCGSherringtonCLordSR, et al.Exercise for falls prevention in Parkinson disease: a randomized controlled trial. Neurology2015; 84: 304–312.
56.
LattariECostaSSCamposC, et al.Can transcranial direct current stimulation on the dorsolateral prefrontal cortex improves balance and functional mobility in Parkinson’s disease?Neurosci Lett2017; 636: 165–169.
57.
HadoushHAl-JarrahMKhalilH, et al.Bilateral anodal transcranial direct current stimulation effect on balance and fearing of fall in patient with Parkinson’s disease. NeuroRehabilitation2018; 42: 63–68.
58.
NascimentoLRNakamura-PalaciosEMBoeningA, et al.Transcranial direct current stimulation (tDCS) in addition to walking training on walking, mobility, and reduction of falls in Parkinson’s disease: study protocol for a randomized clinical trial. Trials2021; 22: 1–7.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
