Structured Abstract
Parkinson's Disease Structured Abstract - P #8
Physical rehabilitation improves motor performance and functional status of clients with Parkinson's disease
CITATION: Patti, F., Reggio, A., Nicoletti, F., Sellaroli, T., Deinite, G., & Nicoletti, F. (1996). Effects of rehabilitation therapy on Parkinsonian's disability and functional independence. Journal of Neurological Rehabilitation, 10, 223-231.
LEVEL OF EVIDENCE: IIB2a
RESEARCH OBJECTIVE/QUESTION
The objective of the study was to provide information on the role of rehabilitation in the care of clients with Parkinson's disease. Two studies were carried out. The first study investigated the effects of rehabilitation on a group of clients with Parkinson's disease who were on a drug regimen of L-dopa and other anti-Parkinson's drugs consistently throughout the period of the study. The second study analyzed the effects of a personalized rehabilitation program on function of participants in the control group who were receiving only adequate doses of anti-Parkinson's drugs.
DESIGN
|
x |
RCT (study 2) |
|
Single Case |
|
Case Control |
| |
Cohort |
x |
Before-After (study 1) |
|
Cross Sectional |
SAMPLING PROCEDURE
All participants were inpatients at the institute of Neurology at the University of Catania. The first study sampled participants consecutively. The second study randomized participants into control and treatment groups that were similar in age, gender, and duration of disease. This randomization was done through a computer-generated list.
SAMPLE
|
N = 28
study 1 = 8
study 2 = 20 |
Mean age
study 1 = 61.7
study 2 = 67.9 |
Male = 19
study 1 = 5
study 2 = 14 |
Female = 9 study 1 = 3
study 2 = 6 |
NUMBER OF PARTICIPANTS IN HOEHN & YAHR'S CLASSIFICATIONS OF PARKINSON'S DISEASE
STAGE I = 0
STAGE II = 3
STAGE III = 15
STAVE IV = 8
STAGE V = 2
EXCLUSION/INCLUSION CRITERIA: All participants had scores on the Mini Mental Status Exam of 27 or higher. Only participants with idiopathic Parkinson's disease were included, which was determined by the following criteria: significant response to levadopa, absence of abnormalities on MRI or CT scans, absence of cerebellar problems such as ataxia or extensor axial rigidity, no impairment of voluntary gaze, and no orthopedic diseases.
OUTCOMES
| |
Life roles |
x |
Tasks |
|
Activities |
|
x |
Abilities/habits |
|
Capacities |
OUTCOME AREAS
|
Outcome Area |
Measures |
Reliability |
Validity |
|
Disability |
Unified Parkinson's disease Rating Scale (UPDRS)
Webster Rating Scale (WRS)
Northwestern University Disability Scale (NUDS) |
NR for all measures |
NR for all measures |
|
Function in ADL |
FIMsm
Barthel Index |
|
|
|
Motor coordination |
Timed UE and LE tasks
Ambulation speed |
|
|
NR=Not Reported
INTERVENTION
Description
An intensive personalized program of PT, OT, and ST was delivered that was different depending on what stage of illness participants were at. Participants in Stage II were treated to correct and prevent musculoskeletal problems, whereas participants in Stage III or above were treated to work on active and passive movements to control for rigidity and to improve gait. In occupational therapy, participants were instructed in compensatory strategies to perform basic ADL and functional mobility.
Who delivered
PTs, OTs, and STs
Setting
Institute of Neurology at the University of Catania
Frequency
Not reported. Programs were individually tailored to patients needs.
Duration
4 weeks
RESULTS
In the first study, eight participants had significantly improved disability scores on the UPDRS from baseline (x = 32.3 ± 22.7) to after 4 weeks of physical therapy (x = 21.5 ± 11.5; p < .05). Participants also had significantly improved function in ADL based on scores from the FIMsm from baseline (x = 98.5 ± 19.9) to 4 weeks after therapy (x = 103.0 ± 15.84; p < .05) and scores from the Barthel Index from baseline (x = 66.87 ± 20.6) to 4 weeks after therapy (x = 74.37 ± 15.7; p < .05). Participants had significantly increased walking speed (p < .05) after 4 weeks of therapy (1.03 ± 0.4) compared with baseline scores (x = .74 ± 0). However, these improvements were not sustained after therapy was discontinued when measured at 2-month follow-up.
In the second study, 12 participants who received physical rehabilitation had significantly improved disability scores on the WRS and NUDS and significantly improved function in ADL on the FIMsm and ambulation speed after 4 weeks of therapy (p < .05). However, only lowered disability scores and ambulation speed were significantly lower than baseline scores when compared at 5-month follow-up. The control participants had significantly worse function in ADL on the FIMsm at the 5-month follow-up compared with baseline. Increased disability scores on the UPDRS and NUDS were found at the 5-month follow-up, compared with baseline scores.
When comparing change scores of treatment and control groups from baseline to 6 months, the treatment group had significantly less disability on the UPDRS (p = .000), WRS (p = .011), and the NUDS (p =. 018) than the control group. The treatment group had significantly better scores on ADL measures of the FIMsm (p = .016) and the Barthel Index (p = .046) than the control group. In addition, ambulation speed was faster in the treatment group than the control group (p = .006).
CONCLUSIONS
Biases - co-intervention, sample size
This study has provided support for the positive effect of rehabilitation therapy on motor performance and functional outcomes of clients with Parkinson's disease. However, there was a tendency for participants to have decreased function after therapy was discontinued. Although participants in the second study were randomized into the control group and treatment group, the control group appears to have had fewer disabilities based on an analysis of baseline scores, although the mean stage of illness was the same for both groups.
COMMENTARY
OT intervention as part of an intensive 4 week rehabilitation program produced positive functional outcomes with clients with Parkinson's disease. However, it is not clear what type of client most benefits from rehabilitation because the group that received therapy appeared to have more disabilities than the control group in this study.
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.
