Education for people with progressive neurological conditions can have negative effects: evidence from a randomized controlled trial.
OBJECTIVE
To test the effects of a home-based educational intervention in reducing the incidence and the risk of falls and pressure sores in adults with progressive neurological conditions.


METHODS
Randomized controlled trial with 12 months follow-up.


METHODS
Participants' homes in the City of Nottingham.


METHODS
One hundred and fourteen people with progressive neurological conditions recruited from general practices in Nottingham, including 53 with Parkinson's disease and 45 with multiple sclerosis.


METHODS
In the education group (EG), baseline data were reviewed by an expert panel which advised on actions most likely to promote each individual's physical, social and psychological well-being. An occupational therapist (OT) then visited EG participants to provide education and information and to discuss a personalized 12-month health action plan. The comparison group (CoG) received standardized printed information delivered to their home.


METHODS
Numbers of participants reporting falls and skin sores at two-monthly phone calls during the follow-up period of 12 months.


RESULTS
The EG reported significantly more falls during the follow-up period and at 12 months (adjusted odds ratio 2.83 (95% CI 1.07-7.47), p=0.036) and significantly more skin sores (adjusted odds ratio 12.74 (95% CI 1.14-142.6), p =0.039) than the CoG. There was no difference between CoG and EG in the Nottingham Extended Activities of Daily Living score, but EG patients showed a significant rise in this score over the study period of 1.62 (95% CI 0.69-2.55, p=0.002).


CONCLUSIONS
Our findings provide evidence that education for people with progressive neurological conditions can have negative effects.
Ward
C D
CD
University of Nottingham, UK. c.d.ward@nottingham.ac.uk
Turpin
G
G
Dewey
M E
ME
Fleming
S
S
Hurwitz
B
B
Ratib
S
S
von Fragstein
M
M
Lymbery
M
M
D000058:Accidental Falls / Q000517:prevention & control*; D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications*; D009422:Nervous System Diseases / Q000150:complications*; D010300:Parkinson Disease / Q000150:complications*; D010353:Patient Education as Topic / Q000379:methods*; D003668:Pressure Ulcer / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D012923:Social Class; D011795:Surveys and Questionnaires; D017211:Treatment Failure; D006113:United Kingdom / Q000453:epidemiology