title: Passive movement therapy in severe paratonia: a multicenter randomized clinical trial.
abstract: BACKGROUND
  Paratonia causes severe movement dysfunction in late stage dementia. Passive Movement Therapy (PMT) is often used to decrease high muscle tone, but the efficacy has never been shown. The objective of this study is to investigate the effect of PMT on muscle tone after two and four weeks of treatment.
  
  
  METHODS
  This study comprised a multicenter single-blinded RCT. Nursing home residents with dementia (according to the DSM-IV-TR criteria) and moderate to severe paratonia were randomly assigned to either a PMT or control group. The PMT group received PMT three times a week over four weeks. The control group received no PMT. The primary outcome was the severity of paratonia as measured by the Modified Ashworth scale (MAS). Secondary outcomes were clinical change (Clinical Global Impression; CGI), caregiver's burden (modified patient specific complaints; PSC), and level of pain during morning care (Pain Assessment Checklist for Elderly with Limited Ability to Communicate, Dutch version; PACSLAC-D). All outcomes were assessed at baseline and after two and four weeks. The MAS, PACSLAC-D, and PSC data were subjected to multilevel mixed linear analysis, and the CGI data to cross-tabulation χ2 analysis.
  
  
  RESULTS
  One-hundred-and-one patients from 12 Dutch nursing homes participated in the study; data from 47 patients in the PME group and 54 controls were analyzed. Patients receiving PMT performed no better in paratonia assessments, nor on CGI, PSC, or PACSLAC-D, than controls in two and four week's time.
  
  
  CONCLUSIONS
  PMT has no beneficial effects and should therefore not be recommended as an intervention in severe paratonia.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN43069940.
authors.affiliation: Dutch Institute of Allied Health Care, Amersfoort, The Netherlands. hobbelen@paramedisch.org
authors.forename: Johannes Hans S M
authors.initials: JH
authors.lastname: Hobbelen
authors.forename: Frans E S
authors.initials: FE
authors.lastname: Tan
authors.forename: Frans R J
authors.initials: FR
authors.lastname: Verhey
authors.forename: Raymond T C M
authors.initials: RT
authors.lastname: Koopmans
authors.forename: Rob A
authors.initials: RA
authors.lastname: de Bie
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000150:complications* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D015915:Motion Therapy, Continuous Passive; D009069:Movement Disorders / Q000209:etiology / Q000628:therapy*; D009483:Neuropsychological Tests; D012720:Severity of Illness Index; D016037:Single-Blind Method; D016896:Treatment Outcome