Multidisciplinary rehabilitation for people with Parkinson’s disease: a randomized controlled study
Journal of Neurology, Neurosurgery, and Psychiatry
Wade DT, Gage H, Owen C, Trend P, Grossmith C, Kaye J Multidisciplinary rehabilitation for people with Parkinson’s disease: a randomized controlled study Journal of Neurology, Neurosurgery, and Psychiatry, 2003 Feb; 74(2):158-62
This article begins by discussing the background of Parkinson’s disease as well as some common treatments for patients. They cited multiple studies that suggest a multidisciplinary treatment approach has shown more benefits for patients regardless of the treatment they choose or are given (medication versus surgery). The authors set out to evaluate the immediate and longer term (4 months later) effectiveness of a 6-week course of rehabilitation from a multidisciplinary team. A total of 94 patients (56 men, mean age 71.3-70.4; criteria: clinically diagnosed with PD, cognitively intact screening measure), began the treatment and were divided into two groups, immediate treatment and delayed treatment. It is notable that all patients in this study went through the treatment, just at different times. Patients were given a disability questionnaire, PDQ-39, SF-36, a health related quality of life measure, stand-walk-sit test (test used to observe gait, balance, and arm strength; often difficult for patients with PD to complete), a test of manual finger dexterity, an anxiety and depression scale, and specific speech questions. The researchers also gave a questionnaire to the carer of the PD patient, to measure carer strain. Patients and carers (N=68; demographic information was not given) were tested at 24 and 48 weeks after onset of treatment. All patients were given individualized rehabilitation plans and attended both individual and group sessions lasting one day per week for six weeks. They study experienced patient drop out and a total of 71 patients had all three assessments. They found that patients worsened across time in the majority of the aforementioned measured areas. They also found that carer strain worsened over the six month time frame. The authors found very mild and inconsistent improvement in mobility of walking in the PD patients that underwent rehabilitation. One of the limitations in this study was the large patient drop out rate. The authors indicated that of those that dropped out, for various reasons, they were the older and more disabled patients at baseline. They hypothesized that mood of the patient and the carer may have worsened at the end of rehabilitation because patients and their family members knew that the treatment was about to be discontinued. Additionally they suggested that when they provided the educational component that patients and their family may have been more distressed as they were more aware of possible deterioration from PD. The authors also noted that maybe 6 sessions (approximately 10 hours) of rehabilitation is not enough and should be increased and further studied in the literature. Generally the authors found that the group of PD patients they studied experienced a decline in abilities over a six month period and that the decline significantly affected the carers involved. They also acknowledged other limitations and suggested possibilities for additional further investigation.