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Liu S, Zhang K, Li X, Li C, Peng M. Effects of the different intensities of task-oriented training on the upper extremity motor function and self-care ability of stroke survivors: study protocol for a multiarm parallel-group randomised controlled trial in a tertiary hospital in China. BMJ Open 2023; 13:e074106. [PMID: 38070930 PMCID: PMC10729097 DOI: 10.1136/bmjopen-2023-074106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 10/19/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Although task-oriented training (TOT) may provide added therapeutic value to stroke survivors, current TOT guidance offers insufficient advice on standardisation, particularly choices of intensity, for clinical practice. Therefore, this study aims to explore the effects of different intensities of TOT on motor function and self-care ability of stroke survivors. METHODS AND ANALYSIS This randomised controlled clinical trial will recruit 72 participants from a tertiary hospital, diagnosed with decreased self-care ability and upper limb motor dysfunction post-stroke. All participants will be randomly assigned to one of three experimental groups or the control group to undergo intervention for 8 weeks. The participants in the control group (n=18) will receive traditional occupational therapy, while those in the experimental groups will receive different intensities of TOT (50%, 75% and 100% intensity for groups A, B and C, respectively). This protocol designed a more innovative and optimised TOT programme to explore the optimal intensity of TOT on stroke survivors. The primary outcome is Canadian Occupational Performance Measure, and the secondary outcomes include Modified Barthel Index, Wolf Motor Function Test and Motor Activity Log. ETHICS AND DISSEMINATION The Second Affiliated Hospital of Hainan Medical University Ethics Committee approved the medical and ethical protocol for this study (LW2022015). All participants will sign an informed consent form. The results will be presented in scientific conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ChiCTR2200056390.
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Affiliation(s)
- Shengfeng Liu
- Department of Rehabilitation Therapy, The Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Kai Zhang
- Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Xuecha Li
- Department of Rehabilitation Therapy, The Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Chunxiang Li
- Department of Rehabilitation Therapy, The Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Mengsi Peng
- Department of Rehabilitation Therapy, The Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
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Capato TTC, Rodrigues R, Cury RG, Teixeira MJ, Barbosa ER. Clinical assessment of upper limb impairments and functional capacity in Parkinson's disease: a systematic review. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:1008-1015. [PMID: 37899049 PMCID: PMC10689111 DOI: 10.1055/s-0043-1772769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/19/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Parkinson's disease (PD) may progressively reduce the upper limb's functionality. Currently, there is no standardized upper limb functional capacity assessment in PD in the rehabilitation field. OBJECTIVE To identify specific outcome measurements to assess upper limbs in PD and access functional capacity. METHODS We systematically reviewed and analyzed the literature in English published from August/2012 to August/2022 according to PRISMA. The following keywords were used in our search: "upper limbs" OR "upper extremity" and "Parkinson's disease." Two researchers searched independently, including studies accordingly to our inclusion and exclusion criteria. Registered at PROSPERO CRD42021254486. RESULTS We found 797 studies, and 50 were included in this review (n = 2.239 participants in H&Y stage 1-4). The most common upper limbs outcome measures found in the studies were: (i) UPDRS-III and MDS-UPDRS to assess the severity and progression of PD motor symptoms (tremor, bradykinesia, and rigidity) (ii) Nine Hole Peg Test and Purdue Pegboard Test to assess manual dexterity; (iii) Spiral test and Funnel test to provoke and assess freezing of upper limbs; (iv) Technology assessment such as wearables sensors, apps, and other device were also found. CONCLUSION We found evidence to support upper limb impairments assessments in PD. However, there is still a large shortage of specific tests to assess the functional capacity of the upper limbs. The upper limbs' functional capacity is insufficiently investigated during the clinical and rehabilitation examination due to a lack of specific outcome measures to assess functionality.
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Affiliation(s)
- Tamine T. C. Capato
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil.
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Nijmegen, The Netherlands.
| | - Rúbia Rodrigues
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil.
| | - Rubens G. Cury
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil.
| | | | - Egberto R. Barbosa
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil.
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Alizadeh N, Packer TL, Sturkenboom I, Eskes G, Warner G. Managing Fatigue in Parkinson's Disease: Protocol for a Pilot Randomized Controlled Trial. Can J Occup Ther 2022; 89:180-189. [PMID: 35287487 PMCID: PMC9136370 DOI: 10.1177/00084174221085449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background. Fatigue is a disabling symptom of Parkinson’s disease (PD). Managing Fatigue: A Six-Week Energy Conservation Intervention was developed to improve the occupational performance of people with fatigue. Efficacy of this program has not been established in PD. Purpose. This study will assess feasibility of the Managing Fatigue: Individual Program (MFIP) delivered via videoconference, the Randomized Controlled Trial (RCT) protocol, and the preliminary effectiveness of the MFIP. Methods. A mixed-methods approach nested in a pilot RCT, randomizing 54 participants 1:1 to usual care or MFIP arms, will be employed to evaluate the feasibility and preliminary effectiveness of MFIP. Qualitative and quantitative data will be collected simultaneously. Implications. Results will identify evidence for establishing protocol requirements for a full-scale RCT. Knowledge of the effectiveness of the one-to-one videoconference delivery format of the program has the potential to enhance the accessibility and the quality of care of the PD population.
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Affiliation(s)
| | - Tanya L. Packer
- Neda Alizadeh, School of Occupational Therapy, 5869 University Ave, Halifax, NS B3H 4R2.
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Tofani M, Ranieri A, Fabbrini G, Berardi A, Pelosin E, Valente D, Fabbrini A, Costanzo M, Galeoto G. Efficacy of Occupational Therapy Interventions on Quality of Life in Patients with Parkinson's Disease: A Systematic Review and Meta-Analysis. Mov Disord Clin Pract 2020; 7:891-901. [PMID: 33163559 DOI: 10.1002/mdc3.13089] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 07/02/2020] [Accepted: 08/27/2020] [Indexed: 02/04/2023] Open
Abstract
Objective To review studies assessing the efficacy of occupational therapy interventions on quality of life in patients with Parkinson's disease. Method We followed the international guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Databases (PubMed, Physiotherapy Evidence Database, OTsekeer, Scopus, Cinhal, and Web of Science) were searched to identify randomized controlled trials of occupational therapy interventions in patients with Parkinson's disease up to 2019 and with no restriction on language. The primary outcome of the meta-analysis was the evaluation of quality of life following occupational therapy interventions. Because of the heterogeneity of the studies, we examined the data by using a random effect model. Results We identified 15 randomized controlled trials that met the inclusion criteria, and 4 of these were included in the meta-analysis. Studies with a follow-up of 2 to 3 months showed that occupational therapy interventions significantly improved the quality of life in patients with Parkinson's disease, with a mean difference of -2.08 (95% confidence interval, -2.52 to -1.64; P < 0.00001). Studies reporting a longer follow-up (6-12 months) also showed that occupational therapy interventions improved the quality of life, with a mean difference of -2.56 (95% confidence interval, -3.52 to -1.61; P < 0.00001). Conclusion Different occupational therapy interventions may be effective in improving the quality of life in patients with Parkinson's disease. However, because of the limited number of studies available, the strength of the evidence should be considered moderate.
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Affiliation(s)
- Marco Tofani
- Department of Public Health and Infectious Diseases Sapienza University of Rome Rome Italy
| | - Alessandro Ranieri
- Department of Anatomy and Locomotor Activity Sapienza University of Rome Rome Italy
| | - Giovanni Fabbrini
- Department Human Neurosciences Sapienza University of Rome Rome Italy.,IRCCS Neuromed Pozzilli Italy
| | - Anna Berardi
- Department Human Neurosciences Sapienza University of Rome Rome Italy
| | - Elisa Pelosin
- Ospedale Policlinico San Martino, IRCCS, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health Unit University of Genoa Genoa Italy
| | - Donatella Valente
- Department Human Neurosciences Sapienza University of Rome Rome Italy.,IRCCS Neuromed Pozzilli Italy
| | | | - Matteo Costanzo
- Department Human Neurosciences Sapienza University of Rome Rome Italy
| | - Giovanni Galeoto
- Department Human Neurosciences Sapienza University of Rome Rome Italy
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Valenti AP, Chita-Tegmark M, Tickle-Degnen L, Bock AW, Scheutz MJ. Using topic modeling to infer the emotional state of people living with Parkinson's disease. Assist Technol 2019; 33:136-145. [PMID: 31194649 DOI: 10.1080/10400435.2019.1623342] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Individuals with Parkinson's disease (PD) often exhibit facial masking (hypomimia), which causes reduced facial expressiveness. This can make it difficult for those who interact with the person to correctly read their emotional state and can lead to problematic social and therapeutic interactions. In this article, we develop a probabilistic model for an assistive device, which can automatically infer the emotional state of a person with PD using the topics that arise during the course of a conversation. We envision that the model can be situated in a device that could monitor the emotional content of the interaction between the caregiver and a person living with PD, providing feedback to the caregiver in order to correct their immediate and perhaps incorrect impressions arising from a reliance on facial expressions. We compare and contrast two approaches: using the Latent Dirichlet Allocation (LDA) generative model as the basis for an unsupervised learning tool, and using a human-crafted sentiment analysis tool, the Linguistic Inquiry and Word Count (LIWC). We evaluated both approaches using standard machine learning performance metrics such as precision, recall, and F1scores. Our performance analysis of the two approaches suggests that LDA is a suitable classifier when the word count in a document is approximately that of the average sentence, i.e., 13 words. In that case, the LDA model correctly predicts the interview category 86% of the time and LIWC correctly predicts it 29% of the time. On the other hand, when tested with interviews with an average word count of 303 words, the LDA model correctly predicts the interview category 56% of the time and LIWC, 74% of the time. Advantages and disadvantages of the two approaches are discussed.
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Affiliation(s)
- Andrew P Valenti
- Tufts University Human-Robot Interaction Laboratory, Medford, Massachusetts, USA
| | - Meia Chita-Tegmark
- Tufts University Human-Robot Interaction Laboratory, Medford, Massachusetts, USA
| | - Linda Tickle-Degnen
- Tufts University Human-Robot Interaction Laboratory, Medford, Massachusetts, USA
| | - Alexander W Bock
- Tufts University Human-Robot Interaction Laboratory, Medford, Massachusetts, USA
| | - Matthias J Scheutz
- Tufts University Human-Robot Interaction Laboratory, Medford, Massachusetts, USA
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Jang JH, Kim H, Jung I, Yoo H. Acupuncture for improving gait disturbance in Parkinson’s disease: A study protocol for a pilot randomized controlled trial. Eur J Integr Med 2018. [DOI: 10.1016/j.eujim.2018.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Golabi P, Sayiner M, Bush H, Gerber LH, Younossi ZM. Patient-Reported Outcomes and Fatigue in Patients with Chronic Hepatitis C Infection. Clin Liver Dis 2017; 21:565-578. [PMID: 28689594 DOI: 10.1016/j.cld.2017.03.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Fatigue is a common symptom. Diagnosis is difficult. Fatigue is often a complex symptom. In the recent years, fatigue has gained considerable amount of attention. It has 2 major types, central and peripheral, which may occur together or alone. Although fatigue has many strong relations with depression and sleep disorders, it is a separate entity. For the diagnosis of fatigue, self-reports and patient-reported outcomes are highly valuable tools because these methods can reflect patients' perceptions. Treating the underlying disease with newly developed direct-acting antivirals often improves the perceived fatigue. Healthy lifestyle changes are the cornerstone of the treatment.
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Affiliation(s)
- Pegah Golabi
- Betty and Guy Beatty Center for Integrated Research, Inova Health system, Claude Moore Health Education and Research Building, 3rd floor, 300 Gallows Road, Falls Church, VA 22042, USA
| | - Mehmet Sayiner
- Betty and Guy Beatty Center for Integrated Research, Inova Health system, Claude Moore Health Education and Research Building, 3rd floor, 300 Gallows Road, Falls Church, VA 22042, USA; Center for Liver Disease, Department of Medicine, Inova Fairfax Hospital, Claude Moore Health Education and Research Building, 3rd floor, 3300 Gallows Road, Falls Church, VA 22042, USA
| | - Haley Bush
- Betty and Guy Beatty Center for Integrated Research, Inova Health system, Claude Moore Health Education and Research Building, 3rd floor, 300 Gallows Road, Falls Church, VA 22042, USA
| | - Lynn H Gerber
- Betty and Guy Beatty Center for Integrated Research, Inova Health system, Claude Moore Health Education and Research Building, 3rd floor, 300 Gallows Road, Falls Church, VA 22042, USA; Center for Liver Disease, Department of Medicine, Inova Fairfax Hospital, Claude Moore Health Education and Research Building, 3rd floor, 3300 Gallows Road, Falls Church, VA 22042, USA
| | - Zobair M Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health system, Claude Moore Health Education and Research Building, 3rd floor, 300 Gallows Road, Falls Church, VA 22042, USA; Center for Liver Disease, Department of Medicine, Inova Fairfax Hospital, Claude Moore Health Education and Research Building, 3rd floor, 3300 Gallows Road, Falls Church, VA 22042, USA.
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Poerbodipoero SJ, Sturkenboom IH, van Hartingsveldt MJ, Nijhuis-van der Sanden MWG, Graff MJ. The construct validity of the Dutch version of the activity card sort. Disabil Rehabil 2015; 38:1943-51. [PMID: 26674067 DOI: 10.3109/09638288.2015.1107779] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Establishing construct validity of the ACS-NL in individuals with Parkinson's disease (PD). METHOD Discriminative validity was established in 191 community-dwelling individuals with PD using an extreme groups design (Hoehn and Yahr stages 1 and 3). Convergent validity was determined by relating the performance scores of the ACS-NL to the scores of the Canadian Occupational Performance Measure (COPM) and the Parkinson's Disease Questionnaire (PDQ-39) scores, and relating ACS-NL satisfaction scores to the COPM scores and to the Utrecht Scale for Evaluation of Rehabilitation Participation (USER-P). RESULTS The ACS-NL discriminated between individuals with PD with H&Y stages 1 and 3 (U = 524.5, Z = -5.453). ACS-NL performance scores correlated weakly with COPM scores (r = (0).19) and moderately with PDQ-39 scores (r = 0.44-0.55). The ACS-NL satisfaction scores correlated weakly with COPM scores (r = 0.23), and moderately with USER-P scores (r ≥ 0.40). CONCLUSIONS This study contributed to the validation of the ACS-NL. The assessment enhances the possibility of monitoring participation in activities in individuals with PD. Implications for Rehabilitation The ACS-NL appears to hold good potential for use in the assessment of participation in activities in individuals with PD. The ACS-NL has added value parallel to administration of other instruments measuring participation (COPM) and quality of life (PDQ-39). This study demonstrates the capacity of the ACS to measure a unique construct of participation and helps to improve the psychometric properties and administration of the ACS-NL in practice.
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Affiliation(s)
- Soemitro J Poerbodipoero
- a Hogeschool Van Amsterdam, Occupational Therapy Research Group, University of Applied Sciences , Amsterdam , The Netherlands
| | - Ingrid H Sturkenboom
- b Department of Rehabilitation , Radboud University Medical Centre , Nijmegen , The Netherlands
| | - Margo J van Hartingsveldt
- a Hogeschool Van Amsterdam, Occupational Therapy Research Group, University of Applied Sciences , Amsterdam , The Netherlands
| | - Maria W G Nijhuis-van der Sanden
- b Department of Rehabilitation , Radboud University Medical Centre , Nijmegen , The Netherlands ;,c Radboud University Medical Centre, Scientific Institute for Quality of Healthcare , Nijmegen , The Netherlands
| | - Maud J Graff
- b Department of Rehabilitation , Radboud University Medical Centre , Nijmegen , The Netherlands ;,c Radboud University Medical Centre, Scientific Institute for Quality of Healthcare , Nijmegen , The Netherlands
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Sturkenboom IH, Nijhuis-van der Sanden MW, Graff MJ. A process evaluation of a home-based occupational therapy intervention for Parkinson's patients and their caregivers performed alongside a randomized controlled trial. Clin Rehabil 2015; 30:1186-1199. [PMID: 26672997 DOI: 10.1177/0269215515622038] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 11/21/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate fidelity, treatment enactment and the experiences of an occupational therapy intervention in Parkinson's disease, to identify factors that affect intervention delivery and benefits. DESIGN Mixed methods alongside a randomized controlled trial. SUBJECTS These include 124 home-dwelling Parkinson's disease patients and their primary caregivers (recipients), and 18 occupational therapists. INTERVENTION Ten-week home-based intervention according to the Dutch guidelines for occupational therapy in Parkinson's disease. MAIN MEASURES Data were collected on intervention dose, protocol process, content of treatment (fidelity), offered and performed strategies (treatment enactment), and recipients' experiences. Therapists' experiences were collected through case note analyses and focus group interviews. RESULTS Mean intervention dose was 9.3 (SD 2.3) hours. Mean protocol process adherence was high (93%; SD 9%), however the intervention did not (fully) address the goal for 268 of 617 treatment goals. Frequencies of offered and performed strategies appeared similar, apart from 'using other tools and materials' which showed a drop from 279 advised to 149 used. The recipients were satisfied overall with the intervention (mean score 8 out of 10). The therapists noted positive or negative influencing factors on both process and benefits: the research context, the socio-political healthcare context, the recipients' personal and contextual factors, and the therapists' competence. CONCLUSION We found some prerequisite factors in equipment provision and available dose important for treatment delivery. Other elicited factors related to, or affected, the required professional competencies and tools to tailor interventions to the complexity of interacting personal and contextual factors of patients and caregivers.
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Affiliation(s)
- Ingrid Hwm Sturkenboom
- Radboud university medical center, Research Institute for Health Sciences, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Maria Wg Nijhuis-van der Sanden
- Radboud university medical center, Research Institute for Health Sciences, Department of Rehabilitation and Department of IQ Healthcare, Nijmegen, The Netherlands
| | - Maud Jl Graff
- Radboud university medical center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation and Department of IQ Healthcare, Nijmegen, The Netherlands
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Sturkenboom IH, Hendriks JC, Graff MJ, Adang EM, Munneke M, Nijhuis-van der Sanden MW, Bloem BR. Economic evaluation of occupational therapy in Parkinson's disease: A randomized controlled trial. Mov Disord 2015; 30:1059-67. [DOI: 10.1002/mds.26217] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 12/29/2014] [Accepted: 02/23/2015] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ingrid H.W.M. Sturkenboom
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Rehabilitation; Nijmegen The Netherlands
| | - Jan C.M. Hendriks
- Radboud university medical center, Department of Health Evidence; Nijmegen The Netherlands
| | - Maud J.L. Graff
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Rehabilitation; Nijmegen The Netherlands
- Radboud university medical center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare; Nijmegen The Netherlands
| | - Eddy M.M. Adang
- Radboud university medical center, Department of Health Evidence; Nijmegen The Netherlands
| | - Marten Munneke
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Neurology; Nijmegen The Netherlands
| | - Maria W.G. Nijhuis-van der Sanden
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Rehabilitation; Nijmegen The Netherlands
- Radboud university medical center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare; Nijmegen The Netherlands
| | - Bastiaan R. Bloem
- Radboud university medical center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology; Nijmegen The Netherlands
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van der Marck MA, Bloem BR. How to organize multispecialty care for patients with Parkinson's disease. Parkinsonism Relat Disord 2014; 20 Suppl 1:S167-73. [PMID: 24262173 DOI: 10.1016/s1353-8020(13)70040-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Neurodegenerative disorders like Parkinson's disease (PD) typically include a broad range of motor and non-motor symptoms. Disease manifestations vary considerably across individuals and, importantly, the individual needs and priorities are highly diverse among patients. It is widely felt that this multifaceted nature of PD calls for a team-oriented and personalized model of care. However, such a multispecialty approach is complex to design, and there are no evidence-based templates that describe how multispecialty care should be organized. Here we elaborate on the various challenges associated with the organization of team-based care. We illustrate this by highlighting new research evidence for two different models of multispecialty team care in PD. We also discuss several critical components of multispecialty care, including composition of the team, collaboration forms between team members, and implementation of multispecialty care within everyday healthcare settings. We close by sharing some of the lessons learned from recent clinical trials on the clinical effectiveness of multispecialty team interventions in PD. This review underscores that designing multispecialty care within the setting of a modern healthcare system is almost as complex as PD itself, and that its scientific evaluation comes with significant challenges.
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Affiliation(s)
- Marjolein A van der Marck
- Radboud University Medical Center; Nijmegen Centre for Evidence Based Practice; Department of Neurology, and Department of Geriatrics; Nijmegen, The Netherlands.
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Maetzler W, Nieuwhof F, Hasmann SE, Bloem BR. Emerging therapies for gait disability and balance impairment: promises and pitfalls. Mov Disord 2014; 28:1576-86. [PMID: 24132846 DOI: 10.1002/mds.25682] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 08/13/2013] [Accepted: 08/13/2013] [Indexed: 12/31/2022] Open
Abstract
Therapeutic management of gait and balance impairment during aging and neurodegeneration has long been a neglected topic. This has changed considerably during recent years, for several reasons: (1) an increasing recognition that gait and balance deficits are among the most relevant determinants of an impaired quality of life and increased mortality for affected individuals; (2) the arrival of new technology, which has allowed for new insights into the anatomy and functional (dis)integrity of gait and balance circuits; and (3) based in part on these improved insights, the development of new, more specific treatment strategies in the field of pharmacotherapy, deep brain surgery, and physiotherapy. The initial experience with these emerging treatments is encouraging, although much work remains to be done. The objective of this narrative review is to discuss several promising developments in the field of gait and balance treatment. We also address several pitfalls that can potentially hinder a fast and efficient continuation of this vital progress. Important issues that should be considered in future research include a clear differentiation between gait and balance as two distinctive targets for treatment and recognition of compensatory mechanisms as a separate target for therapeutic intervention.
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Affiliation(s)
- Walter Maetzler
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, Center of Neurology, University of Tübingen, Tübingen, Germany; German Center for Neurodegenerative Diseases (DNZE), Tübingen, Germany
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13
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Sturkenboom IHWM, Graff MJL, Hendriks JCM, Veenhuizen Y, Munneke M, Bloem BR, Nijhuis-van der Sanden MW. Efficacy of occupational therapy for patients with Parkinson's disease: a randomised controlled trial. Lancet Neurol 2014; 13:557-66. [PMID: 24726066 DOI: 10.1016/s1474-4422(14)70055-9] [Citation(s) in RCA: 149] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is insufficient evidence to support use of occupational therapy interventions for patients with Parkinson's disease. We aimed to assess the efficacy of occupational therapy in improving daily activities of patients with Parkinson's disease. METHODS We did a multicentre, assessor-masked, randomised controlled clinical trial in ten hospitals in nine Dutch regional networks of specialised health-care professionals (ParkinsonNet), with assessment at 3 months and 6 months. Patients with Parkinson's disease with self-reported difficulties in daily activities were included, along with their primary caregivers. Patients were randomly assigned (2:1) to the intervention or control group by a computer-generated minimisation algorithm. The intervention consisted of 10 weeks of home-based occupational therapy according to national practice guidelines; control individuals received usual care with no occupational therapy. The primary outcome was self-perceived performance in daily activities at 3 months, assessed with the Canadian Occupational Performance Measure (score 1-10). Data were analysed using linear mixed models for repeated measures (intention-to-treat principle). Assessors monitored safety by asking patients about any unusual health events during the preceding 3 months. This trial is registered with ClinicalTrials.gov, NCT01336127. FINDINGS Between April 14, 2011, and Nov 2, 2012, 191 patients were randomly assigned to the intervention group (n=124) or the control group (n=67). 117 (94%) of 124 patients in the intervention group and 63 (94%) of 67 in the control group had a participating caregiver. At baseline, the median score on the Canadian Occupational Performance Measure was 4·3 (IQR 3·5-5·0) in the intervention group and 4·4 (3·8-5·0) in the control group. At 3 months, these scores were 5·8 (5·0-6·4) and 4·6 (4·6-6·6), respectively. The adjusted mean difference in score between groups at 3 months was in favour of the intervention group (1·2; 95% CI 0·8-1·6; p<0·0001). There were no adverse events associated with the study. INTERPRETATION Home-based, individualised occupational therapy led to an improvement in self-perceived performance in daily activities in patients with Parkinson's disease. Further work should identify which factors related to the patient, environmental context, or therapist might predict which patients are most likely to benefit from occupational therapy. FUNDING Prinses Beatrix Spierfonds and Parkinson Vereniging.
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Affiliation(s)
| | - Maud J L Graff
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, Netherlands; Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jan C M Hendriks
- Department of Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
| | - Yvonne Veenhuizen
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, Netherlands
| | - Marten Munneke
- Department of Neurology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Radboud University Medical Center, Nijmegen, Netherlands; Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center, Nijmegen, Netherlands.
| | - Maria W Nijhuis-van der Sanden
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, Netherlands; Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, Netherlands
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Canning CG. Rehabilitation in Parkinson's disease the challenge to provide early and ongoing, evidence-based, patient-centred care. ARQUIVOS DE NEURO-PSIQUIATRIA 2013; 71:917-9. [DOI: 10.1590/0004-282x20130228] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 11/12/2013] [Indexed: 11/22/2022]
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Abstract
OBJECTIVES Although fatigue is experienced by everyone, its definition and classification remains under debate. METHODS A review of the previously published data on fatigue. RESULTS Fatigue is influenced by age, gender, physical condition, type of food, latency to last meal, mental status, psychological conditions, personality type, life experience, and the health status of an individual. Fatigue may not only be a symptom but also a measurable and quantifiable dimension, also known as fatigability. Additionally, it may be classified as a condition occurring at rest or under exercise or stress, as physiologic reaction or pathologic condition, as spontaneous phenomenon or triggerable state, as resistant or irresistant to preconditioning, training, or attitude, as prominent or collateral experience, and as accessible or inaccessible to any type of treatment or intervention. Fatigue may be the sole symptom of a disease or one among others. It may be also classified as acute or chronic. Quantification of fatigability is achievable by fatigue scores, force measurement, electromyography, or other means. Fatigue and fatigability need to be delineated from conditions such as sleepiness, apathy, exhaustion, exercise intolerance, lack of vigor, weakness, inertia, or tiredness. Among neurological disorders, the prevalence of fatigue is particularly increased in multiple sclerosis, amyotrophic lateral sclerosis, Parkinson disease, traumatic brain injury, stroke, and bleeding and also in neuromuscular disorders. Fatigue may be influenced by training, mental preconditioning, or drugs. CONCLUSIONS Fatigue needs to be recognized as an important condition that is not only a symptom but may also be quantified and can be modified by various measures depending on the underlying cause.
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Affiliation(s)
| | - Sinda Zarrouk Mahjoub
- Laboratory of Biochemistry, UR "Human Nutrition and Metabolic Disorders" Faculty of Medicine Monastir, Monastir, Tunisie
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