Functional outcomes of an integrated Parkinson's Disease Wellbeing Program

Abstract

Introduction There is growing evidence that exercise provides benefit in treating motor and non‐motor symptoms in Parkinson's disease (PD). Objectives The aims of this study were to determine (a) whether a 5‐week PD‐specific program resulted in sustained physical and psychosocial benefits, and (b) the relationship between patient characteristics, exercise, falls and physical and psychosocial parameters. Design Single‐centre prospective observational study. Methods A total of 135 consecutive patients with mild‐to‐moderate PD underwent a 5‐week PD‐specific education and exercise program from August 2013 to March 2015. Gait, mobility and psychosocial measures were compared at baseline, 6 weeks and 12 months. Results Significant improvements in physical (walking distance in 2 minutes, number of “Sit To Stands” in 30 seconds, time in seconds taken to “Timed Up and Go,” fast gait velocity over 10 m, Berg Balance Scale [BBS]) and psychosocial (quality of life (QoL) [PDQ‐39], depression and anxiety [DASS‐21], and fatigue [PSF‐16]) measures were seen at 6 weeks (all P < .01) with physical improvements sustained at 12 months (all P < .001). The number of patients at 12 months with ≥1 fall reduced from 66% to 33%, and the number not exercising reduced from 42% to 21%. A lack of exercise correlated with ≥1 fall at 12 months (OR 3.39, 95% CI 1.36‐8.39, P = .009). It was also associated with poorer balance and psychosocial parameters at 12 months (all P < .05). Conclusions Patients recruited into a 5‐week Parkinson's disease education and exercise program achieved significant 12‐month benefits in physical but not psychosocial measures. Patients with ≥1 fall post‐treatment were less likely to have been exercising at 12‐month follow‐up.

Structured Care and Self-Management Education for Persons with Parkinson’s Disease: Why the First Does Not Go without the Second—Systematic Review, Experiences and Implementation Concepts from Sweden and Germany

“…Two (11%) programs were restricted to the training of self-management behaviors and associated cognitive behavioral skills [ 25 ], 9 programs (50%) combined self-management support with other therapeutic measures, such as physiotherapy (7, 39%) [ 22 , 24 , 30 , 31 , 32 , 33 , 34 ], occupational therapy (4, 22%) [ 21 , 24 , 31 , 32 ], relaxation and body awareness techniques (7, 39%) [ 21 , 22 , 26 , 28 , 30 , 35 , 36 ] or speech therapy (4, 22%) [ 21 , 22 , 32 , 35 ]. All programs were carried out by healthcare professionals, several (9, 50%) by a multiprofessional team of up to 8 different healthcare professions [ 21 , 23 , 24 , 25 , 28 , 30 , 31 , 32 , 34 ]. Whether the executing staff received training in teaching self-management behaviors, related skills and beliefs, was indicated for 5 programs (28%) [ 26 , 28 , 29 , 32 , 37 ].…”

“…One other study compared program delivery in small groups with home-based self-study [ 29 ]. For 5 programs (28%), a professional teaching manual was reported [ 25 , 26 , 28 , 29 , 32 ], for 4 (22%) teaching manuals and handouts to participants [ 24 , 30 , 32 , 34 ], and for 6 (33%) homework/home exercise programs in between single modules [ 22 , 30 , 31 , 32 , 35 , 37 ]. Only 2 programs (11%) explicitly report the integration of digital components [ 31 , 33 ].…”

“…Both qualitative (3, 13%) [ 23 , 27 , 38 ] and (9, 39%) quantitative studies have been performed for evaluation of PD-related self-management programs [ 21 , 22 , 26 , 30 , 31 , 32 , 34 , 39 , 40 ]. Additionally, 8 (35%) studies combined quantitative data collection with qualitative descriptive aspects for program evaluation [ 24 , 28 , 29 , 36 , 41 , 42 , 43 , 44 ].…”

“…Of the quantitative studies, 3 reached level I according to AACPDM study quality scoring [ 32 , 39 , 44 ], 3 level II [ 29 , 31 , 40 ], 4 level III [ 21 , 26 , 36 , 43 ], 6 level IV [ 22 , 28 , 30 , 34 , 41 , 42 ], and 1 level V [ 24 ]. Controlled trials (10, 43%) compared to standard care [ 21 , 26 , 28 , 31 , 32 , 36 , 39 , 40 , 43 , 44 ], or compared two defined interventions (1, 4%) [ 29 ].…”

“…Evaluation timepoints were at baseline and immediately or with little delay after the last element of respective intervention, and in 6 (26%) at varying intervals (2–12 months) after the intervention ended to assess for sustained effects [ 28 , 29 , 30 , 32 , 34 , 40 ].…”