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Pilot randomised controlled trial of occupational therapy to optimise independence in Parkinson’s disease: The PD OT trial.

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Journal Journal of neurology, neurosurgery, and psychiatry
Year 2009
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This article is included in 2 Systematic reviews Systematic reviews (2 references)

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OBJECTIVE: To perform a pilot trial of occupational therapy (OT) to optimise functional independence in Parkinson disease (PD) to assess accrual/withdrawal rates, acceptability, outcome measures, and inform sample-size calculation. METHOD: Non-demented patients with idiopathic PD and difficulties with activities of daily living (ADL) were recruited provided they had not received OT in the last 2 years and/or physiotherapy in the last year. Patients were randomised to immediate OT or OT after completion of the trial. Patients randomised to OT were assessed at home by an experienced therapist and then received six home treatment sessions over 2 months. Interventions were targeted at functional independence and mobility goals. Outcome measures were: Nottingham Extended Activity of Daily Living Scale, Rivermead Mobility Index, Unified Parkinson’s Disease Rating Scale ADL scale, Parkinson’s Disease Questionnaire 39, EuroQol-EQ-5D, Hospital Anxiety and Depression Scale, and health economics analysis. RESULTS: 39 patients (25 male; mean age 73 years) were recruited from four centres over 16 months. The mean difference in NEADL at 8 months was 3.5 (95% CI -3.2 to 10.2). The mean difference in PDQ-39 Summary Score was 3.8 (95% CI -4.94 to 12.6). There were strong correlations between the PDQ-39 and other outcomes. The intervention was acceptable to patients, with a low withdrawal rate and good questionnaire completion. CONCLUSION: Randomisation to a trial of OT in PD is feasible. NEADL and PDQ-39 are relevant outcomes and provided data to inform sample size for an adequately powered randomised trial for which there is pressing need. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

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Cueing training in the home improves gait-related mobility in Parkinson's disease: The RESCUE trial.

Journal Journal of neurology, neurosurgery, and psychiatry
Year 2007
Links Pubmed DOI PubMed Central

This article is included in 8 Systematic reviews Systematic reviews (8 references)

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[Correction Notice: An erratum for this article was reported in Vol 81(12) of <i>Journal of Neurology, Neurosurgery &amp; Psychiatry</i> (see record [rid]2010-25637-034[/rid]). The original article was published in the journal with an incorrect doi of doi:10.1136/ jnnp.2005.097923. The correct doi is 10.1136/jnnp.2006.097923.] [Correction Notice: An erratum for this article was reported in Vol 81(1) of <i>Journal of Neurology, Neurosurgery &amp; Psychiatry</i> (see record [rid]2010-00264-037[/rid]). This paper was published Online First with an incorrect digital object identifier of 10.1136/jnnp.200X.097923. The DOI should be 10.1136/jnnp.2006.097923.] OBJECTIVES: Gait and mobility problems are difficult to treat in people with Parkinson's disease. The Rehabilitation in Parkinson's Disease: Strategies for Cueing (RESCUE) trial investigated the effects of a home physiotherapy programme based on rhythmical cueing on gait and gait-related activity. METHODS: A single-blind randomised crossover trial was set up, including 153 patients with Parkinson's disease aged between 41 and 80 years and in Hoehn and Yahr stage II-IV. Subjects allocated to early intervention (n = 76) received a 3-week home cueing programme using a prototype cueing device, followed by 3 weeks without training. Patients allocated to late intervention (n = 77) underwent the same intervention and control period in reverse order. After the initial 6 weeks, both groups had a 6-week follow-up without training. Posture and gait scores (PG scores) measured at 3, 6 and 12 weeks by blinded testers were the primary outcome measure. Secondary outcomes included specific measures on gait, freezing and balance, functional activities, quality of life and carer strain. RESULTS: Small but significant improvements were found after intervention of 4.2% on the PG scores (p = 0.005). Severity of freezing was reduced by 5.5% in freezers only (p = 0.007). Gait speed (p = 0.005), step length (p &lt; 0.001) and timed balance tests (p = 0.003) improved in the full cohort. Other than a greater confidence to carry out functional activities (Falls Efficacy Scale, p = 0.04), no carry-over effects were observed in functional and quality of life domains. Effects of intervention had reduced considerably at 6-week follow-up. CONCLUSIONS: Cueing training in the home has specific effects on gait, freezing and balance. The decline in effectiveness of intervention effects underscores the need for permanent cueing devices and follow-up treatment. Cueing training may be a useful therapeutic adjunct to the overall management of gait disturbance in Parkinson's disease. (PsycInfo Database Record (c) 2024 APA, all rights reserved)

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Evaluating rehabilitation using cost-consequences analysis: an example in Parkinson's disease.

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Authors Gage H , Kaye J , Owen C , Trend P , Wade D
Journal Clinical rehabilitation
Year 2006
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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OBJECTIVE: To use cost-consequences analysis to evaluate rehabilitation, and to discuss some practical limitations. DESIGN: Case study of a cost-consequences analysis. SETTING: Day hospital. SUBJECTS: People with Parkinson's disease without major cognitive loss, and their carers. INTERVENTION: A programme of multidisciplinary rehabilitation, delivered for one day per week over six weeks, and including 2 h of individual therapy (physical, occupational, speech and language, specialist nurse) and group activities on each occasion. MAIN MEASURES: COSTS: direct and overhead costs of treatment; participant travel. CONSEQUENCES: patient outcomes (mobility, speech and language, disability, psychological well-being, health-related quality of life); carer outcomes (psychological well-being, health-related quality of life, strain); social service utilization; satisfaction. RESULTS: In this example the main costs were facility's overheads and hospital-provided transport. The consequences of the intervention were improved immediate outcomes for patients that diminished over four months, discovery of unmet social services need, high satisfaction. No benefits for carers were observed. CONCLUSION: A cost-consequences analysis provides a clear descriptive summary for decision-makers that is easier to interpret than cost-effectiveness, cost-utility and cost-benefit analysis. It is a useful technique in rehabilitation research where multiple outcomes and several perspectives (health service, patient, carer) are relevant. However limitations remain: it is difficult to capture all consequences because of data deficiencies and long-term effects; evaluations of individual interventions are partial and do not guarantee economic rationality; local studies may not be generalizable; fixed protocols impede the evaluation of alternative service configurations.

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Efficacy of a physical therapy program in patients with Parkinson's disease: a randomized controlled trial.

Journal Archives of physical medicine and rehabilitation
Year 2005
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This article is included in 11 Systematic reviews Systematic reviews (11 references)

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Objective To investigate the effects of a physical therapy (PT) program in groups of people with Parkinson's disease (PD). Design Randomized controlled trial with a crossover design. Setting Two outpatient rehabilitation clinics in Boston and Amsterdam, respectively. Participants Sixty-eight subjects diagnosed with typical, idiopathic PD, Hoehn and Yahr stage II or III, and stable medication use. Intervention Group A received PT and medication therapy (MT) for the first 6 weeks, followed by MT only for the second 6 weeks. Group B received only MT for the first 6 weeks and PT and MT for the second 6 weeks. Main outcome measures The Sickness Impact Profile (SIP-68), the mobility portion of the SIP-68, the Unified Parkinson's Disease Rating Scale (UPDRS), and comfortable walking speed (CWS) at baseline, 6-week, 12-week, and 3-month follow-up. Results At 6 weeks, differences between groups were significant for the SIP mobility ( P =.015; effect size [ES]=.55), for CWS ( P =.012; ES=.49), for the activities of daily living (ADL) section of the UPDRS ( P =.014; ES=.45), and for the total UPDRS ( P =.007; ES=.56). The total SIP and the mentation and motor sections of the UPDRS did not differ significantly between groups. Significant differences were found at 3 months compared with baseline for CWS, the UPDRS ADL, and total scores. Conclusions People with PD derive benefits in the short term from PT group treatment, in addition to their MT, for quality of life related to mobility, CWS, and ADLs; long-term benefits were found in CWS, UPDRS ADL, and total scores but varied between groups. Copyright © 2005 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

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Occupational therapy in multiple system atrophy: a pilot randomized controlled trial.

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Authors Jain S , Dawson J , Quinn NP , Playford ED
Journal Movement disorders : official journal of the Movement Disorder Society
Year 2004
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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There is some evidence that rehabilitation therapies may be useful in progressive neurological conditions, but this usefulness has not been studied in multiple system atrophy (MSA) to date. The aim of this small pilot study was to identify the feasibility of a larger randomized controlled trial of occupational therapy and to report preliminary data on the impact of occupational therapy on disability, mood, and health-related quality of life in patients with MSA. Patient groups were comparable for age, gender distribution, type of MSA, and severity. The active occupational therapy intervention group experienced a significant reduction of Unified Parkinson's Disease Rating Scale (total score and Activities of Daily Living [ADL] section), and PDQ-39 scores (total scores and ADL subsection). An occupational therapy program may improve functional abilities in patients with mild to moderate MSA. A larger multicenter study is needed.

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Multidisciplinary rehabilitation for people with Parkinson's disease: a randomised controlled study.

Journal Journal of neurology, neurosurgery, and psychiatry
Year 2003
Links Pubmed DOI PubMed Central

This article is included in 8 Systematic reviews Systematic reviews (8 references)

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OBJECTIVE: To determine whether a programme of multidisciplinary rehabilitation and group support achieves sustained benefit for people with Parkinson's disease or their carers. METHODS: The study was a randomised controlled crossover trial comparing patients and carers who had received rehabilitation four months before assessment with those who had not. Patients were recruited from a neurology clinic, attended a day hospital from home weekly for six weeks using private car or hospital transport, and received group educational activities and individual rehabilitation from a multidisciplinary team. Patients were assessed at entry and at six months using a 25 item self assessment Parkinson's disease disability questionnaire, Euroqol-5d, SF-36, PDQ-39, hospital anxiety and depression scale, and timed stand-walk-sit test. Carers were assessed using the carer strain index and Euroqol-5d. RESULTS: 144 people with Parkinson's disease without severe cognitive losses and able to travel to hospital were registered (seven were duplicate registrations); 94 had assessments at baseline and six months. Repeated measures analysis of variance comparing patients at the 24 week crossover point showed that those receiving rehabilitation had a trend towards better stand-walk-sit score (p = 0.093) and worse general and mental health (p = 0.002, p = 0.019). Carers of treated patients had a trend towards more strain (p = 0.086). Analysis comparing patients before and six months after treatment showed worsening in disability, quality of life, and carer strain. CONCLUSIONS: Patients with Parkinson's disease decline significantly over six months, but a short spell of multidisciplinary rehabilitation may improve mobility. Follow up treatments may be needed to maintain any benefit.

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Swallowing and voice effects of Lee Silverman Voice Treatment (LSVT): a pilot study.

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Journal Journal of neurology, neurosurgery, and psychiatry
Year 2002
Links Pubmed PubMed Central

This article is included in 3 Systematic reviews Systematic reviews (3 references)

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OBJECTIVE: To define the effects of Lee Silverman Voice Treatment (LSVT on swallowing and voice in eight patients with idiopathic Parkinson's disease. METHODS: Each patient received a modified barium swallow (MBS) in addition to voice recording before and after 1 month of LSVT. Swallowing motility disorders were defined and temporal measures of the swallow were completed from the MBS. Voice evaluation included measures of vocal intensity, fundamental frequency, and the patient's perception of speech change. RESULTS: before LSVT, the most prevalent swallowing motility disorders were oral phase problems including reduced tongue control and strength. Reduced tongue base retraction resulting in residue in the vallecula was the most common disorder in the pharyngeal stage of the swallow. Oral transit time (OTT) and pharyngeal transit time (PTT) were prolonged. After LSVT, there was an overall 51% reduction in the number of swallowing motility disorders. Some temporal measures of swallowing were also significantly reduced as was the approximate amount of oral residue after 3 ml and 5 ml liquid swallows. Voice changes after LSVT included a significant increase in vocal intensity during sustained vowel phonation as well as during reading. CONCLUSIONS: LSVT seemingly improved neuromuscular control of the entire upper aerodigestive tract, improving oral tongue and tongue base function during the oral and pharyngeal phases of swallowing as well as improving vocal intensity.

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Aerobic exercise intervention improves aerobic capacity and movement initiation in Parkinson's disease patients.

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Journal NeuroRehabilitation
Year 2002
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This article is included in 3 Systematic reviews Systematic reviews (3 references)

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Parkinson's Disease (PD) is a progressive neurologic disorder, which includes an inability to activate appropriate muscle activity. Very little research has analyzed aerobic exercise for PD patients. The purpose of this study was to investigate the effect of a 16 week aerobic exercise intervention on aerobic capacity and movement initiation (MI) time for PD patients. With 8 PD subjects (Hoehn & Yahr stage 2), 4 completed the exercise intervention. Peak VO_2scores significantly improved (26%) Choice MI improved from 532 ms to 415 ms, while simple MI improved from 285 ms to 261 ms. The improvement in aerobic capacity suggests that PD patients may benefit from exercise just as much as a normal population. The change in MI indicates that aerobic exercise may reduce the detrimental effects of neuromuscular slowing within PD patients, by improving the subjects' ability to initiate and perform appropriate movement patterns.

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Randomized controlled trial of the Alexander Technique for idiopathic Parkinson's disease.

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Journal Clinical rehabilitation
Year 2002
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This article is included in 3 Systematic reviews Systematic reviews (3 references)

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Determined whether the Alexander Technique (ALT), alongside normal treatment, would be of benefit to people disabled by idiopathic Parkinson's disease (PD). Subjects (Ss) in the randomized controlled trial were 93 people with clinically confirmed idiopathic PD. 29 Ss (mean age 64.1 yrs) received 24 lessons in the ALT, and 29 Ss (mean age 66.1 yrs) received 24 sessions of massage. 30 Ss comprised the control (no intervention) group. The main outcome measure was the Self-Assessment Parkinson's Disease Disability Scale (SPDDS) at best and at worst times of day. Secondary measures included the Beck Depression Inventory and an Attitudes to Self Scale. Measures were taken pre- and post-intervention, and at 6-mo follow-up. Results show that the ALT group improved compared with the control group, pre-intervention to post-intervention, both on the SPDDS at best, and on the SPDDS at worst. The comparative improvement was maintained at 6-mo follow-up. The ALT group was comparatively less depressed post-intervention, and at 6-mo follow-up had improved on the Attitudes to Self Scale. It is concluded there is evidence that lessons in the ALT are likely to lead to sustained benefit for people with PD. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

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Short-term effectiveness of intensive multidisciplinary rehabilitation for people with Parkinson's disease and their carers.

Authors Trend P , Kaye J , Gage H , Owen C , Wade D
Journal Clinical rehabilitation
Year 2002
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This article is included in 7 Systematic reviews Systematic reviews (7 references)

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OBJECTIVE: To evaluate the short-term effectiveness of an intensive multidisciplinary rehabilitation programme for people with Parkinson's disease and their carers. DESIGN: Observational, with assessments before and after intervention. SETTING: An elderly care day unit in a district general hospital in south-east England. SUBJECTS: One hundred and eighteen people with Parkinson's disease and no cognitive impairment, and their carers. INTERVENTION: Participants attended the day hospital in groups of six patients with their carers for one day per week over six consecutive weeks. After assessment, they received individual treatment from a specialist team. Weekly group activities included relaxation and talks from experts. OUTCOME MEASURES: Patients and carers were assessed for: health-related quality of life, psychological well-being, social services need, perceptions of the programme. Patients were additionally assessed for mobility, gait and speech. Carers were assessed for strain. RESULTS: After treatment significant improvements were recorded in patients' mobility and gait (p < 0.05), speech (p < 0.001), depression (p = 0.029), health-related quality of life (p = 0.001). People with more advanced disease at baseline gained significantly more from treatment (p < or = 0.04). Carers were less depressed and had higher health-related quality of life than patients at baseline (p < 0.001) and no improvements in these indicators were recorded after treatment. A high unmet need for social services was identified in 31% of participants, and 10% of carers were found in danger of being unable to continue caring. Participants reported knowledge gains and high levels of satisfaction with both individual therapies and group activities. CONCLUSIONS: This intensive co-ordinated programme provided immediate benefits to people with Parkinson's disease and their carers.