title: Occupational therapy for patients with Parkinson's disease.
abstract: BACKGROUND
  Despite drug and surgical therapies for Parkinson's disease, patients develop progressive disability. The role of the occupational therapist is to support the patient and help them maintain their usual level of self-care, work and leisure activities for as long as possible. When it is no longer possible to maintain their usual activities, occupational therapists support individuals in changing and adapting their relationship with their physical and social environment to develop new valued activities and roles.
  
  
  OBJECTIVE
  To compare the efficacy and effectiveness of occupational therapy with placebo or no interventions (control group) in patients with Parkinson's disease.
  
  
  METHODS
  Relevant trials were identified by electronic searches of MEDLINE, EMBASE, CINAHL, ISI-SCI, AMED, MANTIS, REHABDATA, REHADAT, GEROLIT, Pascal, LILACS, MedCarib, JICST-EPlus, AIM, IMEMR, SIGLE, ISI-ISTP, DISSABS, Conference Papers Index, Aslib Index to Theses, the Cochrane Controlled Trials Register, the CentreWatch Clinical Trials listing service, the metaRegister of Controlled Trials, ClinicalTrials.gov, CRISP, PEDro, NIDRR and NRR; and the reference lists of identified studies and other reviews were examined.
  
  
  METHODS
  Only randomised controlled trials (RCT) were included, however those trials that allowed quasi-random methods of allocation were allowed.
  
  
  METHODS
  Data was abstracted independently by two authors and differences were settled by discussion.
  
  
  RESULTS
  Two trials were identified with 84 patients in total. Although both trials reported a positive effect from occupational therapy, all of the improvements were small. The trials did not have adequate placebo treatments, used small numbers of patients and the method of randomisation and concealment of allocation was not specified in one trial. These methodological problems could potentially lead to bias from a number of sources reducing the strength of the studies further.
  
  
  CONCLUSIONS
  Considering the significant methodological flaws in the studies, the small number of patients examined, and the possibility of publication bias, there is insufficient evidence to support or refute the efficacy of occupational therapy in Parkinson's disease. There does not appear to be a consensus as to the best practice in occupational therapy when treating people with Parkinson's disease. A survey of therapists is needed to determine what methods of occupational therapy are currently being used by therapists to treat Parkinson's disease, and whether there is a consensus as to 'best-practice'. Large well designed placebo-controlled RCTs are needed to demonstrate occupational therapy's effectiveness in Parkinson's disease. Outcome measures with particular relevance to patients, carers, occupational therapists and physicians should be chosen and the patients monitored for at least six months to determine the duration of benefit. The trials should be reported using CONSORT guidelines.
authors.affiliation: Department of Neurology, City Hospital NHS Trust, Dudley Road, Birmingham, West Midlands, UK, B18 7QH. c.e.clarke@bham.ac.uk
authors.forename: K H
authors.initials: KH
authors.lastname: Deane
authors.forename: C
authors.initials: C
authors.lastname: Ellis-Hill
authors.forename: E D
authors.initials: ED
authors.lastname: Playford
authors.forename: Y
authors.initials: Y
authors.lastname: Ben-Shlomo
authors.forename: C E
authors.initials: CE
authors.lastname: Clarke
mesh_terms: D006801:Humans; D009788:Occupational Therapy; D010300:Parkinson Disease / Q000534:rehabilitation*; D016032:Randomized Controlled Trials as Topic