Multidisciplinary rehabilitation for people with Parkinson's disease: a randomised controlled study.
OBJECTIVE
To determine whether a programme of multidisciplinary rehabilitation and group support achieves sustained benefit for people with Parkinson's disease or their carers.


METHODS
The study was a randomised controlled crossover trial comparing patients and carers who had received rehabilitation four months before assessment with those who had not. Patients were recruited from a neurology clinic, attended a day hospital from home weekly for six weeks using private car or hospital transport, and received group educational activities and individual rehabilitation from a multidisciplinary team. Patients were assessed at entry and at six months using a 25 item self assessment Parkinson's disease disability questionnaire, Euroqol-5d, SF-36, PDQ-39, hospital anxiety and depression scale, and timed stand-walk-sit test. Carers were assessed using the carer strain index and Euroqol-5d.


RESULTS
144 people with Parkinson's disease without severe cognitive losses and able to travel to hospital were registered (seven were duplicate registrations); 94 had assessments at baseline and six months. Repeated measures analysis of variance comparing patients at the 24 week crossover point showed that those receiving rehabilitation had a trend towards better stand-walk-sit score (p = 0.093) and worse general and mental health (p = 0.002, p = 0.019). Carers of treated patients had a trend towards more strain (p = 0.086). Analysis comparing patients before and six months after treatment showed worsening in disability, quality of life, and carer strain.


CONCLUSIONS
Patients with Parkinson's disease decline significantly over six months, but a short spell of multidisciplinary rehabilitation may improve mobility. Follow up treatments may be needed to maintain any benefit.
Wade
D T
DT
Oxford Centre for Enablement, Windmill Road, Oxford OX3 7LD, UK. derick.wade@dial.pipex.com
Gage
H
H
Owen
C
C
Trend
P
P
Grossmith
C
C
Kaye
J
J
D000203:Activities of Daily Living / Q000145:classification / Q000523:psychology; D000368:Aged; D017028:Caregivers / Q000523:psychology; D003131:Combined Modality Therapy / Q000379:methods; D017281:Cost of Illness; D018592:Cross-Over Studies; D003631:Day Care, Medical; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000523:psychology / Q000534:rehabilitation*; D010348:Patient Care Team; D011788:Quality of Life / Q000523:psychology; D016037:Single-Blind Method