The accredited CME learning activity based on this article is offered under the auspices of the CE department of the University of Toronto. Participating physicians are entitled to one (1) MAINPRO-M1 credit by completing this program, found online at www.geriatricsandaging.ca/cme.htm

Kevin D. Gross PT, PhD, Boston University Clinical Epidemiology Research and Training Unit, and the Department of Medicine at Boston Medical Center, Boston, MA, U.S.A.
David J. Hunter MBBS, PhD, Boston University Clinical Epidemiology Research and Training Unit, and the Department of Medicine at Boston Medical Center, Boston, MA, U.S.A.

Despite the increasing prevalence of symptomatic knee osteoarthritis, many uncertainties exist pertaining to its management. Many putative risk factors are characterized by excessive loading of vulnerable joint structures. Clinical examination includes assessment of knee function and the influence of modifiable risks such as malalignment, muscle strength, and obesity. Knee braces, footwear, exercises, and dieting are prescribed for the purpose of improving the distribution of loads on the knee, and reducing the likelihood that osteoarthritis (OA) and its symptoms will worsen. In this conservative approach, pharmaceuticals of low toxicity are preferred and given only when other methods fail to achieve functional improvement.
Key words: knee osteoarthritis, mechanical risk factors, nonpharmacologic management, physiotherapy, joint replacement.

Susan Maddock, RPT, Specialized Geriatric Services, Sunnybrook & Women’s College Health Sciences Centre, University of Toronto, Toronto, ON.

Susan Gal, BScPE, BHScPT, Specialized Geriatric Services, Sunnybrook & Women’s College Health Sciences Centre, University of Toronto, Toronto, ON.

MaryJane McIntyre, BScPT, Specialized Geriatric Services, Sunnybrook & Women’s College Health Sciences Centre, University of Toronto, Toronto, ON.

Rory H. Fisher, MB, FRCP(Ed)(C), Division of Geriatric Medicine, Department of Medicine, Sunnybrook & Women’s College Health Sciences Centre, University of Toronto, Toronto, ON.

Barbara A. Liu, MD, FRCPC, Division of Geriatric Medicine, Department of Medicine, Sunnybrook & Women’s College Health Sciences Centre, University of Toronto; Program Director, Regional Geriatric Program of Toronto, Toronto, ON.

The Falls Prevention Program at Sunnybrook & Women’s College Health Sciences Centre was developed to provide patients with an evidence-based, multidisciplinary intervention to prevent falls. The goals of the program are to decrease the incidence of falls and improve patient confidence. Participants in the program are 65 or older with a history of falls or near-falls and are living in the community. Participants complete a 45-minute exercise circuit, twice a week for six weeks. In addition, patients undergo geriatric medical assessment and are seen by an occupational therapist for home safety education. Patients report fewer falls during the intervention and at follow-up, and subjectively report that they benefit from the program. The positive effects of this program support existing evidence that multidisciplinary intervention plays an important role in fall prevention.

Key words: falls prevention, older adults, exercise, balance, multidisciplinary, physiotherapy.

K.H.O. Deane, BSc, PhD and C.E. Clarke, BSc, MD, FRCP, Department of Neurosciences, The University of Birmingham and City Hospital, Birmingham, UK.

Many clinicians, therapists and patients support the use of rehabilitation in the treatment of Parkinson's disease. However, systematic reviews reveal a lack of conclusive evidence to support the use of common forms of rehabilitation therapy in this movement disorder. Lack of evidence of efficacy is not proof of lack of effect. Large pragmatic randomized controlled trials are required to determine the effectiveness and safety of rehabilitation therapies for people with Parkinson's disease.
Key words: Parkinson's disease, occupational therapy, physiotherapy, speech therapy, rehabilitation.