Structured Abstract
Parkinson's Disease Structured Abstract - P #10
Exercise may improve function in clients with Parkinson's disease
CITATION: Hurwitz, A. (1989). The benefit of a home exercise regimen for ambulatory Parkinson's disease patients. Journal of Neuroscience Nursing, 21, 180-184.
LEVEL OF EVIDENCE: IIB2b
RESEARCH OBJECTIVE/QUESTION
The objective of this study was to determine the effect of a home exercise regimen on the ability of clients with Parkinson's disease to maintain self-care. Self-care was defined as the ability to perform all activities of daily living independently and included mobility, feeding, and other self-care activities.
Research question: What effect would an exercise regimen have on clients' ability to maintain self-care?
DESIGN
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RCT |
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Single Case |
x |
Case Control |
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Cohort |
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Before-After |
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Cross Sectional |
SAMPLING PROCEDURE
This was a convenience sample. Sampling was done through referral of nurses, physicians, and social agencies in the Brooklyn area.
SAMPLE
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N = 29 |
Mean age = 72 |
Male = 22 |
Female = 7 |
NUMBER OF PARTICIPANTS IN HOEHN & YAHR'S CLASSIFICATIONS OF PARKINSON'S DISEASE
STAGE I = 15
STAGE II = 12
STAGE III = 2
STAGE IV = 0
EXCLUSION/INCLUSION CRITERIA: All participants had Parkinson's disease, lived at home, and had not been hospitalized within the 6 months prior to the study. People were excluded from the study if they were beyond Stage III of illness (according to Hoehn and Yahr's classifications), were unwilling to have weekly home visits by a nurse or nursing student, or presented other medical or social conditions that would interfere with visiting the client weekly, such as a cardiac condition that prohibited exercise.
ATTRITION: One person dropped out of the treatment group. Originally, there were 30 people in the sample.
OUTCOMES
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Life roles |
x |
Tasks |
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Activities |
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Abilities/habits |
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Capacities |
OUTCOME AREAS
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Outcome Area |
Measures |
Reliability |
Validity |
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Self-care |
Parkinson's Home Visit Assessment Tool |
Test-retest done 7-14 days after it was administered to 30 different Parkinson's disease clients (r=.82) |
NR |
NR=Not Reported
INTERVENTION
Description
Home visits were made to assigned clients in the control and treatment groups. In addition to administering the outcome measure, the treatment group received 30 minutes of exercise that consisted of head-to-toe range of motion and five to ten minutes of cool down. In addition to the intervention, all participants in the treatment group reported performing the exercises daily. About half of the participants in the control group reported performing some form of exercise on their own.
Who delivered
14 senior nursing students
Setting
Clients' homes
Frequency
Once a week, session length not reported
Duration
Visits continued for an 8-month period
RESULTS
No significant results were found on the "self-care" section of the outcome measure. Clients in the treatment group experienced improvement in the ability to suck through a straw.
CONCLUSIONS
Biases - contamination, co-intervention, sample size, dropouts
The authors concluded that exercise may be a factor that promotes self-care in ADL for clients with Parkinson's disease; however, participants in the treatment group did not show significant improvement in the areas that were most directly related to self-care on the outcome measure (e.g.,. needs help generally, with shoes, buttons, and zipper and has a gait disturbance). There were other limitations, such as a small sample size and no interrater reliability study among the 14 nursing students who administered the Parkinson's Home Visit Assessment Tool.
COMMENTARY
In this study, participants who had Parkinson's disease received a structured 30-minute session of exercise one time a week and reported performing the exercises daily between the home visits by nurses. These participants demonstrated some improvements in function over participants in the control group, but no specific improvements in self-care (according to the authors' definition) were found. However, there was a major threat to internal validity of the study. Interrater reliability was not conducted among the 14 student nurse raters; therefore, it is unclear if the students were rating clients similarly on the outcome measure. Also, some students may have observed self-care of clients whereas others simply asked clients to report self-care status.
Terminology used in this document is based on two systems of classification current at the time the evidence-based literature reviews were completed: Uniform Terminology for Occupational Therapy Practice-Third Edition (AOTA, 1994) and International Classification of Functioning, Disability and Health (ICIDH-2) (World Health Organization [WHO], 1999). More recently, the Uniform Terminology document was replaced by Occupational Therapy Practice Framework: Domain and Process (AOTA, 2002), and modifications to ICIDH-2 were finalized in the International Classification of Functioning, Disability and Health (WHO, 2001).
This work is based on the evidence-based literature review completed by Susan Murphy, ScD, OTR/L, and Linda Tickle-Degnen, PhD, OTR/L, FAOTA.
For more information about the Evidence-Based Literature Review Project, contact the Practice Department at the American Occupational Therapy Association, 301-652-6611, x 2040.
Copyright 2003 American Occupational Therapy Association, Inc. All rights reserved. This material may be reproduced and distributed without prior written consent.
