Structured Abstract
Parkinson's Disease Structured Abstract - P #2
Health education and promotion may improve ADL status and self-efficacy in clients with Parkinson's disease
CITATION: Montgomery, E. B., Jr., Lieberman, A., Singh, G., & Fries, J. F. (1994). Patient education and health promotion can be effective in Parkinson's disease: A randomized controlled trial. American Journal of Medicine, 97, 429-435.
LEVEL OF EVIDENCE: IA3b
RESEARCH OBJECTIVE/QUESTION
The objective of this program was to investigate the effectiveness of an educational program designed to improve function in activities of daily living by enhancing personal self-efficacy and physical function in clients with Parkinson's disease.
DESIGN
|
x |
RCT |
|
Single Case |
|
Case Control |
| |
Cohort |
|
Before-After |
|
Cross Sectional |
SAMPLING PROCEDURE
Four hundred consecutive enrollment cards from the PROPATH program, an ongoing free program sponsored by a pharmaceutical company for people taking specific medications, were selected and clients were contacted. Informed consent was obtained from 322 clients, and they were randomly assigned to the control or treatment group.
SAMPLE
|
N = 290 |
Mean age: treatment grp = 68.1 (N=155),
control grp = 70.6 (N=167) |
Male = NR |
Female = NR |
NR = Not reported
NUMBER OF PARTICIPANTS IN HOEHN & YAHR'S CLASSIFICATIONS OF PARKINSON'S DISEASE
STAGE I = NR
STAGE II = NR
STAGE III = NR
STAGE IV = NR
EXCLUSION/INCLUSION CRITERIA: None listed
ATTRITION: Originally there were 322 participants; only 290 completed the study.
OUTCOMES
| |
Life roles |
x |
Tasks |
|
Activities |
| |
Abilities/habits |
x |
Capacities |
OUTCOME AREAS
|
Outcome area |
Measures |
Reliability |
Validity |
|
Function in ADL |
United Parkinson's Disease Rating Scale (UPDRS) |
NR for any measures |
NR for any measures |
|
Perceived self-efficacy |
Battery of 15 questions |
|
|
|
Self-reported exercise |
UPDRS |
|
|
NR=Not Reported
INTERVENTION
Description
The PROPATH program was administered through the mail. An initial questionnaire was completed at baseline and again at 2, 4, and 6 months. Participants reported their age, perceived disease severity, medications they were taking, and side effects experienced. Reports, which were mailed, were individualized for each participant based on the above variables and included appropriate exercise recommendations, diet, control of side effects, and other educational information. At each 2-month cycle, summary reports were mailed to the participants' physicians that included a listing of suggestions made to participants and additional suggestions for the physicians to consider. At 6 months a quality of life measure was given to the control and treatment groups.
Who delivered
N/A
Setting
N/A
Frequency
Mailed information at baseline, 2, 4, and 6 months
Duration
6 months
RESULTS
Participants in the treatment group reported greater improvements in their ability to perform activities of daily living (ADL) at their best periods of the day (which appears to be when people feel the best and are most functional) and at their worst periods of the day compared with the control group at the 6 month follow-up period. The treatment and control group differed significantly in their ability to perform ADL during their best periods of the day (p = .033) and during their worst periods of the day (p = .011). The change scores for the treatment group representing function during the best periods of the day were .37 ± .83 and the change scores for the control group were 2.96 ± .88. The change scores for the treatment group representing function during the worst periods of the day were -.48 ± 1.01 and the change scores for the control group were 32.0 ± 1.5. Participants in the treatment group reported significantly more total self-efficacy (posttest x = 904.0 ± 24), which encompasses beliefs about controlling symptoms, improving timed function in ADL, and managing disease problems, than the control group (post-test x = 795.0 ± 22; p < .01). Both the control and treatment group had significant increases in reported exercise; however, the treatment group had a significant increase in the percentage of participants reporting exercise (20%) over the control group (10.6%; p = .001).
CONCLUSIONS
Biases - contamination, co-intervention, dropouts, expectation
Participants reported significant benefits from this program, which is very cost-effective and completed entirely by mail delivery. However, there are threats to internal validity of the study. All instruments were self-report, and validity and reliability of these instruments were not reported. The investigators had no contact with the participants of the study other than through the mail. There was no method to check on the accuracy of self-report data. Also, the physicians of the participants were contacted through the mail at each 2-month cycle with reports of suggestions that were given to their clients by this program. Physicians may have encouraged their clients who were in the treatment group, which may have influenced them or caused them to respond more positively on the questionnaires.
COMMENTARY
This study provides some support for the notion that education and exercise promotion can improve function in ADL in clients with Parkinson's disease. However, it is difficult to know how accurate the data were in this study based on self-reported function through the mail.
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.
