Self-management rehabilitation and health-related quality of life in Parkinson's disease: a randomized controlled trial.
The purpose of this randomized controlled trial was to determine whether increasing hours of self-management rehabilitation had increasing benefits for health-related quality of life (HRQOL) in Parkinson's disease beyond best medical treatment, whether effects persisted at 2 and 6 months of follow-up, and whether targeted compared with nontargeted HRQOL domains responded more to rehabilitation. Participants on best medication therapy were randomly assigned to one of three conditions for 6 weeks intervention: 0 hours of rehabilitation; 18 hours of clinic group rehabilitation plus 9 hours of attention control social sessions; and 27 hours of rehabilitation, with 18 in clinic group rehabilitation and 9 hours of rehabilitation designed to transfer clinic training into home and community routines. Results (N = 116) showed that at 6 weeks, there was a beneficial effect of increased rehabilitation hours on HRQOL measured with the Parkinson's Disease Questionnaire-39 summary index (F(1,112) = 6.48, eta = 0.23, CI = 0.05-0.40, P = 0.01). Benefits persisted at follow-up. The difference between 18 and 27 hours was not significant. Clinically relevant improvement occurred at a greater rate for 18 and 27 hours (54% improved) than for 0 hours (18% improved), a significant 36% difference in rates (95% CI = 20-52% 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.
Tickle-Degnen
Linda
L
Department of Occupational Therapy, Tufts University, Medford, Massachusetts 02155, USA. Linda.Tickle_Degnen@tufts.edu
Ellis
Terry
T
Saint-Hilaire
Marie H
MH
Thomas
Cathi A
CA
Wagenaar
Robert C
RC
D000368:Aged; D003131:Combined Modality Therapy / Q000379:methods; D004185:Disability Evaluation; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000523:psychology* / Q000534:rehabilitation* / Q000628:therapy; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life / Q000523:psychology; D012648:Self Care / Q000379:methods; D012720:Severity of Illness Index; D012944:Social Support; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome