The impact of occupational therapy in Parkinson's disease: a randomized controlled feasibility study.
OBJECTIVE
To evaluate the feasibility of a randomized controlled trial including process and potential impact of occupational therapy in Parkinson's disease.


METHODS
Process and outcome were quantitatively and qualitatively evaluated in an exploratory multicentre, two-armed randomized controlled trial at three months.


METHODS
Forty-three community-dwelling patients with Parkinson's disease and difficulties in daily activities, their primary caregivers and seven occupational therapists.


METHODS
Ten weeks of home-based occupational therapy according to the Dutch guidelines of occupational therapy in Parkinson's disease versus no occupational therapy in the control group.


METHODS
Process evaluation measured accrual, drop-out, intervention delivery and protocol adherence. Primary outcome measures of patients assessed daily functioning: Canadian Occupational Performance Measure (COPM) and Assessment of Motor and Process Skills. Primary outcome for caregivers was caregiver burden: Zarit Burden Inventory. Participants' perspectives of the intervention were explored using questionnaires and in-depth interviews.


RESULTS
Inclusion was 23% (43/189), drop-out 7% (3/43) and unblinding of assessors 33% (13/40). Full intervention protocol adherence was 74% (20/27), but only 60% (71/119) of baseline Canadian Occupational Performance Measure priorities were addressed in the intervention. The outcome measures revealed negligible to small effects in favour of the intervention group. Almost all patients and caregivers of the intervention group were satisfied with the results. They perceived: 'more grip on the situation' and used 'practical advices that make life easier'. Therapists were satisfied, but wished for a longer intervention period.


CONCLUSIONS
The positive perceived impact of occupational therapy warrants a large-scale trial. Adaptations in instructions and training are needed to use the Canadian Occupational Performance Measure as primary outcome measure.
Department of Rehabilitation, Nijmegen Centre of Evidence Based Practice, Radboud University Nijmegen Medical Centre, The Netherlands. i.sturkenboom@reval.umcn.nl
Ingrid H
IH
Sturkenboom
Maud J
MJ
Graff
George F
GF
Borm
Yvonne
Y
Veenhuizen
Bastiaan R
BR
Bloem
Marten
M
Munneke
Maria W
MW
Nijhuis-van der Sanden
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D017028:Caregivers; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009788:Occupational Therapy; D010043:Outcome and Process Assessment, Health Care; D010300:Parkinson Disease / Q000150:complications / Q000523:psychology / Q000534:rehabilitation*; D010349:Patient Compliance; D017060:Patient Satisfaction