Falls and balance: physiotherapy at home for NDIS participants

Falls are common, and for many people living with disability, worry about falling can be as limiting as a fall itself. This guide explains why falls happen, what the research says about exercise and falls, what a home-visit physio assessment involves, and how NDIS funding can be used.

Why do falls happen?

Falls rarely have just one cause. Researchers and falls-prevention bodies describe a mix of factors [1][2]:

  • Personal factors: reduced strength or balance, changes in walking, vision problems, dizziness, some medications, fatigue, continence urgency, and the effects of conditions such as stroke, MS, Parkinson's disease, brain injury or intellectual disability.

  • Environmental factors: poor lighting, loose rugs, clutter, steps without rails, slippery bathrooms, and pets underfoot.

  • Activity factors: rushing, carrying things, or doing tasks that are near the limit of what feels safe.

Because the causes differ from person to person, a useful plan starts with an individual assessment.

What does the evidence say?

Most falls research has been done with older adults living in the community, and the findings are strong in that group:

  • A Cochrane review of 108 trials (average participant age 76) found high-certainty evidence that exercise reduces the rate of falls in people aged 60 and over living in the community, with balance and functional exercises showing a clear effect [3].

  • The World Guidelines for Falls Prevention and Management for Older Adults (2022) recommend exercise that includes balance-challenging and functional activities, tailored and progressed over time, and a multifactorial assessment for people at high risk of falling [1].

  • The Australian and New Zealand Falls Prevention Society (ANZFPS) promotes the study and implementation of falls prevention, and shares information and resources [2].

Evidence for younger adults with disability is more limited and varies by condition. For example, a Cochrane review in Parkinson's disease found physiotherapy improved some balance measures over the short term but showed no difference in falls [4]. Research findings describe groups of people, so they can't predict how any one person will respond. Your physio should explain what's known for your situation, and what isn't.

Why work on balance at home?

Most falls happen during ordinary daily activities. A home visit allows your physiotherapist to:

  • See your actual environment: the steps, bathroom, bed height and lighting you deal with every day.

  • Practise real tasks: getting up from your own chair or bed, turning in a tight hallway, or managing the front step.

  • Check equipment where you use it: walking aids, shower chairs, rails, and whether they still suit you. Your physio can help you and your team consider whether an equipment review or occupational therapy referral may be useful.

  • Involve your supports: family or support workers can learn how to help safely, if you want them involved.

What happens in a falls and balance assessment?

A home-visit assessment usually includes:

  1. Your history: any falls or near-misses, what you were doing at the time, your conditions and medications, and your goals.

  2. Physical testing: standard measures of balance, strength, walking and getting up from a chair.

  3. A look around your home, with your permission, noting hazards and what's working well.

  4. A plan: often a home exercise program focusing on balance and strength, plus practical suggestions and, where relevant, suggestions to discuss with your GP (for example a medication review or vision check).

Balance exercise generally needs to be challenging enough to be useful while staying safe, so it's set at the right level for you and progressed over time [1][3]. The Safe Exercise at Home website, an Australian physiotherapy-led resource, has general guidance and exercise programs for older people and people with mobility limitations [5].

Simple steps you can take now

These are general suggestions only; your physio can tailor them:

  • Keep walkways clear and remove or secure loose rugs.

  • Use night lights between the bedroom and bathroom.

  • Wear well-fitting, enclosed footwear around the house.

  • Get up slowly, especially after sitting or lying for a while.

  • Keep your walking aid within reach and in good repair.

  • If you have a fall, tell your GP and your support team, even if you weren't hurt.

If someone has fallen and is badly hurt, has hit their head, or can't get up, call 000.

Using your NDIS plan

Physiotherapy related to your disability and goals is commonly funded under Capacity Building – Improved Daily Living [6]. Thrive charges in line with the NDIS Pricing Arrangements and Price Limits [7].

Self-managed and plan-managed participants can use registered or unregistered providers; NDIA-managed participants must use registered providers [8].

About Thrive United Physio: we provide home-visit physiotherapy for adults with NDIS plans in Melbourne's south-east, inner south and west, and right across Melbourne, and we're currently taking new referrals. We are not a registered NDIS provider (registration is in progress), so we can only see self-managed and plan-managed participants. Visits are delivered by an Ahpra-registered physiotherapist.

To ask about a referral, use the form at thriveunitedphysio.com.au or call 0426 207 796. We reply within 48 hours.

This article is general information, not medical advice. Talk to your doctor or physiotherapist about your situation.

Sources

  1. Montero-Odasso M, et al. World guidelines for falls prevention and management for older adults: a global initiative. Age and Ageing. 2022;51(9):afac205. https://doi.org/10.1093/ageing/afac205

  2. Australian and New Zealand Falls Prevention Society (ANZFPS). https://anzfallsprevention.org/

  3. Sherrington C, et al. Exercise for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews. 2019;(1):CD012424. https://doi.org/10.1002/14651858.CD012424.pub2

  4. Tomlinson CL, et al. Physiotherapy versus placebo or no intervention in Parkinson's disease. Cochrane Database of Systematic Reviews. 2013;(9):CD002817. https://doi.org/10.1002/14651858.CD002817.pub4

  5. Safe Exercise at Home. https://www.safeexerciseathome.org.au

  6. NDIS. What are capacity building supports. https://www.ndis.gov.au/participants/using-your-funding/different-budget-types/what-are-capacity-building-supports

  7. NDIS. Pricing arrangements. https://www.ndis.gov.au/providers/pricing-and-payments/pricing/pricing-arrangements

  8. NDIS. What is a provider. https://www.ndis.gov.au/participants/working-providers/get-know-your-providers/what-provider

Ask about falls and balance physiotherapy at home

For NDIS self-managed and plan-managed participants. We reply within 48 hours.

Submit a Referral Enquire About Our Service