Self‐management rehabilitation and health‐related quality of life in Parkinson's disease: A randomized controlled trial

Abstract

The purpose of this randomized controlled trial was to determine if increasing hours of selfmanagement rehabilitation had increasing benefits for health-related quality of life (HRQOL) in Parkinson's disease beyond best medical treatment, if effects persisted at two and six months follow-up, and if targeted compared to non-targeted HRQOL domains responded more to rehabilitation. Participants on best medication therapy were randomized to one of three conditions for six weeks intervention: 0 hrs of rehabilitation; 18 hrs of clinic group rehabilitation plus 9 hrs of attention control social sessions; and 27 hrs of rehabilitation, with 18 in clinic group rehabilitation and 9 hrs of rehabilitation designed to transfer clinic training into home and community routines. Results (N = 116) showed that at six weeks there was a beneficial effect of increased rehabilitation hours on HRQOL measured with the Parkinson's Disease Questionnaire-39 summary index (eta = .23, CI = .05 -.40, p =.01). Benefits persisted at follow-up. The difference between 18 and 27 hrs was not significant. Clinically relevant improvement occurred at a greater rate for 18 and 27 hrs (54% improved) than for 0 hrs (18% improved), a significant 36% difference in rates (95% CI = 20% to 52% difference). Effects were largest in two targeted domains: communication and mobility. More concerns with mobility and activities of daily living at baseline predicted more benefit from rehabilitation. KeywordsClinical trials Randomized controlled (CONSORT agreement); Health-related Quality of life; Parkinson's disease/Parkinsonism; Rehabilitation Health-related quality of life (HRQOL) is one's perceived health and well-being in personally valued domains of daily life.1 , 2 Parkinson's disease (PD) symptoms compromise HRQOL by making it difficult to participate in valued activities and roles of home and NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript community life. Yet individuals who feel mastery over life activities and maintain participation in them experience less depression and more well-being.3 , 4 Effective management of PD begins with considering the person's HRQOL and promoting a sense of control in valued life domains that realistically are within the person's capacity to influence. 5 , 6 Our meta-analyses of previous studies found rehabilitation to improve performance in mobility and self-care activities in 25% more individuals with PD compared to control conditions.7 -9 Recent studies have strengthened the evidence that rehabilitation benefits HRQOL.10 -12 Few of these studies implemented well-defined interventions and tested effects with randomized controlled trials, and fewer yet attempted to test varying intensities of rehabilitation.13 Consequently we developed a specific, best practice rehabilitation intervention and used a randomized-controlled trial to test the effects of differing rehabilitation intensities on health-related quality of life.An interdisciplinary team of physical, occupational, and speech therapists ...

Relationships between activity and well‐being in people with parkinson's disease

“…In addition to the beneficial long‐term benefits of physical exercise (Ellis et al., 2011; Monticone et al., 2015; Sharp & Hewitt, 2014; Tickle‐Degnen et al., 2010; for reviews see Foster et al., 2014; Goodwin et al., 2008; Schenkman et al., 2012), the results point to almost immediate interactions between periods of activity in daily life and the subjective condition. Patients should therefore be encouraged to increase their activity levels by means of specialized programs as well as on an everyday basis.…”

“…In this context, specific activating therapies, such as interdisciplinary rehabilitation (Monticone, Ambrosini, Laurini, Rocca, & Foti, 2015), self‐management programs (Tickle‐Degnen, Ellis, Saint‐Hilaire, Thomas, & Wagenaar, 2010), health promotion programs (Montgomery et al., 1994), physical activity training (for reviews see Foster, Bedekar, & Tickle‐Degnen, 2014), and dance (for a review see Sharp & Hewitt, 2014) have shown positive effects on both motor and nonmotor symptoms as well as on quality of life.…”

Multidisciplinary care of patients with Parkinson's disease

“…The study showed improved quality of life immediately after the intervention and at six months. 20 Potential barriers to the implementation of effective multidisciplinary care include: insufficient expertise among health professionals, poor interdisciplinary collaboration, poor communication, and lack of financial support for a multidisciplinary team approach. 21 Some of the above may have contributed to the disappointing trial results.…”

Choral singing therapy following stroke or Parkinson’s disease: an exploration of participants’ experiences

“…While short-term speech language therapy after acute stroke is generally provided, long-term care for people with stroke or PD is not routine, resulting in many unmet needs [22][23][24]. New approaches are needed, which are low-cost, person-centred, and easily accessible, to enhance treatment provision and enable long-term self-management of chronic conditions [25,26].…”