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Karatana Ö, Yıldız B. The Relationship Between Religious Coping, Spirituality, and Disease Self-Management Among Parkinson's Patients in Turkey. JOURNAL OF RELIGION AND HEALTH 2024; 63:2125-2139. [PMID: 37985590 DOI: 10.1007/s10943-023-01950-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 11/22/2023]
Abstract
Religion and spirituality can be important motivational tools in the management of Parkinson's disease. This study was conducted to determine the relationship between religious coping methods, spirituality, and disease self-management levels in Parkinson's patients. This descriptive, cross-sectional, and correlational study was conducted with 294 Parkinson's patients. Descriptive statistics, independent samples t test, one-way analysis of variance, Pearson correlation coefficient, and structural equation modeling were used in the analysis of the data. This study showed that Parkinson's patients adopted both positive and negative religious coping styles, demonstrated good levels of spirituality, and had high levels of disease self-management. A statistically significant relationship was found between the positive and negative religious coping levels of Parkinson's patients and their levels of spirituality and disease self-management (p < 0.05). Health professionals may consider and support Parkinson's patients' use of religion as a coping mechanism, as this may help manage Parkinson's disease.
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Affiliation(s)
| | - Baykal Yıldız
- Kocaeli Darıca Farabi Training and Research Hospital, Neurology Clinic, Kocaeli, Turkey
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Isernia S, Di Tella S, Rossetto F, Borgnis F, Realdon O, Cabinio M, Pagliari C, Torchio A, Castagna A, Blasi V, Silveri MC, Baglio F. Exploring cognitive reserve's influence: unveiling the dynamics of digital telerehabilitation in Parkinson's Disease Resilience. NPJ Digit Med 2024; 7:116. [PMID: 38710915 DOI: 10.1038/s41746-024-01113-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/12/2024] [Indexed: 05/08/2024] Open
Abstract
Telerehabilitation is emerging as a promising digital method for delivering rehabilitation to Parkinson's Disease (PD) patients, especially in the early stages to promote brain resilience. This study explores how cognitive reserve (CR), the brain's ability to withstand aging and disease, impacts the effectiveness of telerehabilitation. It specifically examines the influence of lifelong cognitive activities on the relationship between neural reserve and improved functional abilities following rehabilitation. In the study, 42 PD patients underwent a 4-month neuromotor telerehabilitation program. CR proxies were assessed using the Cognitive Reserve Index questionnaire (CRIq), brain changes via 3T-MRI, and functional response through changes in the 6-Minute Walk Distance (6MWD). Participants were divided into responders (n = 23) and non-responders (n = 19) based on their 6MWD improvement. A multiple regression model was run to test significant predictors of 6MWD after treatment in each group. The results revealed a significant correlation between 6MWD and CRIq scores, but only among responders. Notably, the CRIq Leisure-Time sub-index, along with baseline 6MWD, were predictors of post-treatment 6MWD. These findings highlight CR's role in enhancing the benefits of telerehabilitation on PD patients' neuromotor functions. Clinically, these results suggest that neurologists and clinicians should consider patients' lifestyles and cognitive engagement as important factors in predicting and enhancing the outcomes of telerehabilitation. The study underscores the potential of CR as both a predictor and booster of telerehabilitation's effects, advocating for a personalized approach to PD treatment that takes into account individual CR levels.
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Affiliation(s)
- Sara Isernia
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy.
| | - Sonia Di Tella
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | | | | | - Olivia Realdon
- Department of Human Sciences for Education, University of Milano-Bicocca, Milan, Italy
| | - Monia Cabinio
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | | | | | - Anna Castagna
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Valeria Blasi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
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Li J, Aulakh N, Culum I, Roberts AC. Adherence to Non-Pharmacological Interventions in Parkinson's Disease: A Rapid Evidence Assessment of the Literature. JOURNAL OF PARKINSON'S DISEASE 2024:JPD230266. [PMID: 38640167 DOI: 10.3233/jpd-230266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
Background Low adherence to non-pharmacological interventions can impact treatment effectiveness. Yet, there is limited information on adherence barriers and facilitators to non-pharmacological interventions in Parkinson's disease (PD). Objective 1) To examine the quality of adherence reporting and 2) to identify key determinants of adherence to PD non-pharmacological interventions. Methods A rapid evidence assessment was conducted, following PRISMA guidelines, that included controlled studies of exercise, physiotherapy, occupational therapy, speech-language therapy with explicit reporting of 'adherence' OR 'compliance', published in the last 15 years. Data extracted included: adherence rates, adherence outcomes, and factors associated with adherence. A collaborative thematic analysis was conducted to identify determinants of adherence. Results The search yielded 2,445 articles of which 114 met criteria for full screening with 45 studies meeting all inclusion criteria. High quality adherence data that aligned with the intervention goals were reported by 22.22%(N = 10) of studies, with the majority reporting attendance/attrition rates only 51.11%(N = 23). Four major themes (34 subthemes) emerged: disease and health, personal, program design, and system and environmental. Conclusions There has been limited progress in the quality of adherence reporting in PD non-pharmacological interventions over the last decade. Acknowledging this limitation, key determinants of adherence included: alignment with personal beliefs, attitudes, and expectations; the demands of the intervention and worsening disease symptoms and personal/time obligations; and accessibility and safety concerns. Program design elements found to facilitate adherence included: opportunities for social engagement and in-person offerings linked to higher levels of interventionist support, performative feedback, and social reinforcement.
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Affiliation(s)
- John Li
- Faculty of Health Sciences, Western University, School of Communication Sciences and Disorders, London, Ontario Canada
| | - Nimrit Aulakh
- Faculty of Health Sciences, Western University, School of Communication Sciences and Disorders, London, Ontario Canada
| | - Ivan Culum
- Faculty of Health Sciences, Western University, School of Communication Sciences and Disorders, London, Ontario Canada
- Canadian Centre for Activity and Aging, London, Ontario Canada
| | - Angela C Roberts
- Faculty of Health Sciences, Western University, School of Communication Sciences and Disorders, London, Ontario Canada
- Faculty of Science, Western University, Department of Computer Science, London, Ontario Canada
- Canadian Centre for Activity and Aging, London, Ontario Canada
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Colón-Semenza C, Zajac JA, Schwartz A, Darbandsari P, Ellis TD. Experiences from the implementation of physical therapy via telehealth for individuals with Parkinson disease during the COVID-19 pandemic. Disabil Rehabil 2024; 46:1593-1601. [PMID: 37088939 DOI: 10.1080/09638288.2023.2202418] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 04/08/2023] [Indexed: 04/25/2023]
Abstract
PURPOSE To (1) determine the characteristics and participation rate of adults with Parkinson disease (PD) in physical therapy (PT) delivered via telehealth, (2) identify the outcome measures and interventions implemented, (3) determine the safety of and (4) patient and therapist satisfaction with PT via telehealth in a clinic specializing in the care of people with PD during the coronavirus pandemic. MATERIALS & METHODS A retrospective analysis of PT services via telehealth was conducted. Participating patients completed a satisfaction survey. Physical therapists (PTs) who delivered this care were interviewed. Three coders conducted thematic analysis of interviews. Descriptive statistics described the participation rate, demographics, outcome measures, interventions, and safety. RESULTS There was a 71.4% participation rate. Participants (n = 55) were white (96%), non-Hispanic (100%), older adult (mean = 69.5 years (8.3)) males (65.5%). Non-participants (n = 22) had similar demographics. Therapists selected patient-reported measures more often than performance-based measures. Therapeutic exercise was the most common intervention. All patients (80% response rate) reported satisfaction with their experience. PTs reported the home enhanced specificity of training but impeded evaluation. Therapists endorsed a hybrid model for future practice. CONCLUSIONS Patients reported satisfaction with PT via telehealth during the pandemic. A hybrid model may support optimal delivery of PT.IMPLICATIONS FOR REHABILITATIONPhysical therapy via telehealth for patients with Parkinson disease was acceptable to patients and physical therapists in our study.Physical therapy via telehealth was safe for people with Parkinson disease in our study, although availability and benefits may not be reaching all populations equitably.Both physical therapists and patients endorse a hybrid model of care (a combination of in-person and remote assessment and treatment) to profit from the strengths of in-person and virtual formats while minimizing barriers to access.
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Affiliation(s)
- C Colón-Semenza
- Department of Kinesiology, University of Connecticut, Storrs, CT, USA
| | - J A Zajac
- Department of Physical Therapy, Boston University, Boston, MA, USA
| | - A Schwartz
- Department of Occupational Therapy, MGH Institute of Health Professions, Boston, MA, USA
| | - P Darbandsari
- Department of Kinesiology, University of Connecticut, Storrs, CT, USA
| | - T D Ellis
- Department of Physical Therapy, Boston University, Boston, MA, USA
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Goetz ME, Ford CB, Greiner MA, Clark A, Johnson KG, Kaufman BG, Mantri S, Xian Y, O'Brien RJ, O'Brien EC, Lusk JB. Racial Disparities in Low-Value Care in the Last Year of Life for Medicare Beneficiaries With Neurodegenerative Disease. Neurol Clin Pract 2024; 14:e200273. [PMID: 38524836 PMCID: PMC10955333 DOI: 10.1212/cpj.0000000000200273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/09/2024] [Indexed: 03/26/2024]
Abstract
Background and Objectives There are racial disparities in health care services received by patients with neurodegenerative diseases, but little is known about disparities in the last year of life, specifically in high-value and low-value care utilization. This study evaluated racial disparities in the utilization of high-value and low-value care in the last year of life among Medicare beneficiaries with dementia or Parkinson disease. Methods This was a retrospective, population-based cohort analysis using data from North and South Carolina fee-for-service Medicare claims between 2013 and 2017. We created a decedent cohort of beneficiaries aged 50 years or older at diagnosis with dementia or Parkinson disease. Specific low-value utilization outcomes were selected from the Choosing Wisely initiative, including cancer screening, peripheral artery stenting, and feeding tube placement in the last year of life. Low-value outcomes included hospitalization, emergency department visits, neuroimaging services, and number of days receiving skilled nursing. High-value outcomes included receipt of occupational and physical therapy, hospice care, and medications indicated for dementia and/or Parkinson disease. Results Among 70,650 decedents, 13,753 were Black, 55,765 were White, 93.1% had dementia, and 7.7% had Parkinson disease. Adjusting for age, sex, Medicaid dual enrollment status, rural vs urban location, state (NC and SC), and comorbidities, Black decedents were more likely to receive low-value care including colorectal cancer screening (adjusted hazard ratio [aHR] 1.46 [1.32-1.61]), peripheral artery stenting (aHR 1.72 [1.43-2.08]), and feeding tube placement (aHR 2.96 [2.70-3.24]) and less likely to receive physical therapy (aHR 0.73 [0.64-0.85)], dementia medications (aHR 0.90 [0.86-0.95]), or Parkinson disease medications (aHR 0.88 [0.75-1.02]) within the last year of life. Black decedents were more likely to be hospitalized (aHR 1.28 [1.25-1.32]), more likely to be admitted to skilled nursing (aHR 1.09 [1.05-1.13]), and less likely to be admitted to hospice (aHR 0.82 [0.79-0.85]) than White decedents. Discussion We found racial disparities in care utilization among patients with neurodegenerative disease in the last year of life, such that Black decedents were more likely to receive specific low-value care services and less likely to receive high-value supportive care than White decedents, even after adjusting for health status and socioeconomic factors.
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Affiliation(s)
- Margarethe E Goetz
- Departments of Neurology (MEG, KGJ, SM, RJOB, ECOB, JBL), Population Health Sciences (CBF, AC, BGK, ECOB, MAG), and Psychiatry and Behavioral Sciences (KGJ), Duke University, Durham, NC; Departments of Population and Data Sciences (YX), and Neurology (YX), University of Texas-Southwestern, Dallas; Duke University School of Medicine (JBL); and Duke University Fuqua School of Business (JBL), Durham, NC
| | - Cassie B Ford
- Departments of Neurology (MEG, KGJ, SM, RJOB, ECOB, JBL), Population Health Sciences (CBF, AC, BGK, ECOB, MAG), and Psychiatry and Behavioral Sciences (KGJ), Duke University, Durham, NC; Departments of Population and Data Sciences (YX), and Neurology (YX), University of Texas-Southwestern, Dallas; Duke University School of Medicine (JBL); and Duke University Fuqua School of Business (JBL), Durham, NC
| | - Melissa A Greiner
- Departments of Neurology (MEG, KGJ, SM, RJOB, ECOB, JBL), Population Health Sciences (CBF, AC, BGK, ECOB, MAG), and Psychiatry and Behavioral Sciences (KGJ), Duke University, Durham, NC; Departments of Population and Data Sciences (YX), and Neurology (YX), University of Texas-Southwestern, Dallas; Duke University School of Medicine (JBL); and Duke University Fuqua School of Business (JBL), Durham, NC
| | - Amy Clark
- Departments of Neurology (MEG, KGJ, SM, RJOB, ECOB, JBL), Population Health Sciences (CBF, AC, BGK, ECOB, MAG), and Psychiatry and Behavioral Sciences (KGJ), Duke University, Durham, NC; Departments of Population and Data Sciences (YX), and Neurology (YX), University of Texas-Southwestern, Dallas; Duke University School of Medicine (JBL); and Duke University Fuqua School of Business (JBL), Durham, NC
| | - Kim G Johnson
- Departments of Neurology (MEG, KGJ, SM, RJOB, ECOB, JBL), Population Health Sciences (CBF, AC, BGK, ECOB, MAG), and Psychiatry and Behavioral Sciences (KGJ), Duke University, Durham, NC; Departments of Population and Data Sciences (YX), and Neurology (YX), University of Texas-Southwestern, Dallas; Duke University School of Medicine (JBL); and Duke University Fuqua School of Business (JBL), Durham, NC
| | - Brystana G Kaufman
- Departments of Neurology (MEG, KGJ, SM, RJOB, ECOB, JBL), Population Health Sciences (CBF, AC, BGK, ECOB, MAG), and Psychiatry and Behavioral Sciences (KGJ), Duke University, Durham, NC; Departments of Population and Data Sciences (YX), and Neurology (YX), University of Texas-Southwestern, Dallas; Duke University School of Medicine (JBL); and Duke University Fuqua School of Business (JBL), Durham, NC
| | - Sneha Mantri
- Departments of Neurology (MEG, KGJ, SM, RJOB, ECOB, JBL), Population Health Sciences (CBF, AC, BGK, ECOB, MAG), and Psychiatry and Behavioral Sciences (KGJ), Duke University, Durham, NC; Departments of Population and Data Sciences (YX), and Neurology (YX), University of Texas-Southwestern, Dallas; Duke University School of Medicine (JBL); and Duke University Fuqua School of Business (JBL), Durham, NC
| | - Ying Xian
- Departments of Neurology (MEG, KGJ, SM, RJOB, ECOB, JBL), Population Health Sciences (CBF, AC, BGK, ECOB, MAG), and Psychiatry and Behavioral Sciences (KGJ), Duke University, Durham, NC; Departments of Population and Data Sciences (YX), and Neurology (YX), University of Texas-Southwestern, Dallas; Duke University School of Medicine (JBL); and Duke University Fuqua School of Business (JBL), Durham, NC
| | - Richard J O'Brien
- Departments of Neurology (MEG, KGJ, SM, RJOB, ECOB, JBL), Population Health Sciences (CBF, AC, BGK, ECOB, MAG), and Psychiatry and Behavioral Sciences (KGJ), Duke University, Durham, NC; Departments of Population and Data Sciences (YX), and Neurology (YX), University of Texas-Southwestern, Dallas; Duke University School of Medicine (JBL); and Duke University Fuqua School of Business (JBL), Durham, NC
| | - Emily C O'Brien
- Departments of Neurology (MEG, KGJ, SM, RJOB, ECOB, JBL), Population Health Sciences (CBF, AC, BGK, ECOB, MAG), and Psychiatry and Behavioral Sciences (KGJ), Duke University, Durham, NC; Departments of Population and Data Sciences (YX), and Neurology (YX), University of Texas-Southwestern, Dallas; Duke University School of Medicine (JBL); and Duke University Fuqua School of Business (JBL), Durham, NC
| | - Jay B Lusk
- Departments of Neurology (MEG, KGJ, SM, RJOB, ECOB, JBL), Population Health Sciences (CBF, AC, BGK, ECOB, MAG), and Psychiatry and Behavioral Sciences (KGJ), Duke University, Durham, NC; Departments of Population and Data Sciences (YX), and Neurology (YX), University of Texas-Southwestern, Dallas; Duke University School of Medicine (JBL); and Duke University Fuqua School of Business (JBL), Durham, NC
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Duvdevani M, Yogev-Seligmann G, Schlesinger I, Nassar M, Erich I, Hadad R, Kafri M. Association of health behaviors with function and health-related quality of life among patients with Parkinson's disease. Isr J Health Policy Res 2024; 13:2. [PMID: 38173041 PMCID: PMC10763356 DOI: 10.1186/s13584-023-00588-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/28/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Current evidence on chronic conditions favors promotion of health behaviors as a mean to positively impact health outcomes. In Parkinson's disease, performing health behaviors is indicated as a means to fight the long-lasting burden of the disease. Understanding actual engagement in health behaviors and patient activation and their association to function and health-related quality of life is therefore important. Our objectives were, among people with Parkinson's disease: (1) to characterize health behaviors including utilization of rehabilitative treatments, physical activity, and patient activation levels, and (2) to test the associations between these health behaviors and health outcomes. METHODS A cross-sectional study of 88 people with Parkinson's disease (age 66.84 ± 8.8) was conducted. Participants answered questionnaires measuring health behaviors including utilization of health professions treatments, physical activity, patient activation, and health outcomes consisting of function and health-related quality of life. Linear regression models were conducted to test associations between measured health behaviors, function and health-related quality of life. RESULTS Participants rarely engage in rehabilitative treatments, but showed high levels of patient activation. Controlled by demographics and disease severity, physical activity and patient activation were associated with function (b = 0.41, p < .001; b = 0.2, p = .02, respectively) and physical activity but not patient activation, which was associated with health-related quality of life (b = 0.19, p = .03). There was also interaction effects of physical activity and non-motor symptoms, and physical activity and motor symptoms on health-related quality of life (b = 0.19, p = .02 and b = - 0.22, p = .01, respectively). CONCLUSIONS In respect to their potential health-related benefits for people with Parkinson's disease, health professionals' treatments are underutilized. Findings supported the importance of health behaviors for maintaining function and health-related quality of life among people with Parkinson's disease. They also show a differential contribution of motor and non-motor symptoms to the association between physical activity and quality of life. It is suggested that policy makers encourage opportunities for physical activity tailored for people with Parkinson's disease and adopt a proactive stance towards enhancing awareness and use of rehabilitation services. Trial registration NCT05211700, ClinicalTrials.gov ID: NCT05211700 first release 12/30/2021, https://classic. CLINICALTRIALS gov/ct2/show/NCT05211700.
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Affiliation(s)
- Michal Duvdevani
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, POB 3338, 3103301, Haifa, Israel
| | - Galit Yogev-Seligmann
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, POB 3338, 3103301, Haifa, Israel.
| | - Ilana Schlesinger
- Movement Disorders Institute, Department of Neurology, Rambam Health Care Campus, Haifa, Israel
- Technion Faculty of Medicine, Haifa, Israel
| | - Maria Nassar
- Movement Disorders Institute, Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Ilana Erich
- Movement Disorders Institute, Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Rafi Hadad
- Movement Disorders Institute, Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Michal Kafri
- Department of Physical Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
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Goldman JG, Volpe D, Ellis TD, Hirsch MA, Johnson J, Wood J, Aragon A, Biundo R, Di Rocco A, Kasman GS, Iansek R, Miyasaki J, McConvey VM, Munneke M, Pinto S, St Clair KA, Toledo S, York MK, Todaro R, Yarab N, Wallock K. Delivering Multidisciplinary Rehabilitation Care in Parkinson's Disease: An International Consensus Statement. JOURNAL OF PARKINSON'S DISEASE 2024; 14:135-166. [PMID: 38277303 PMCID: PMC10836578 DOI: 10.3233/jpd-230117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
BACKGROUND Parkinson's disease (PD) is a complex neurodegenerative disorder impacting everyday function and quality of life. Rehabilitation plays a crucial role in improving symptoms, function, and quality of life and reducing disability, particularly given the lack of disease-modifying agents and limitations of medications and surgical therapies. However, rehabilitative care is under-recognized and under-utilized in PD and often only utilized in later disease stages, despite research and guidelines demonstrating its positive effects. Currently, there is a lack of consensus regarding fundamental topics related to rehabilitative services in PD. OBJECTIVE The goal of the international Parkinson's Foundation Rehabilitation Medicine Task Force was to develop a consensus statement regarding the incorporation of rehabilitation in PD care. METHODS The Task Force, comprised of international multidisciplinary experts in PD and rehabilitation and people directly affected by PD, met virtually to discuss topics such as rehabilitative services, existing therapy guidelines and rehabilitation literature in PD, and gaps and needs. A systematic, interactive, and iterative process was used to develop consensus-based statements on core components of PD rehabilitation and discipline-specific interventions. RESULTS The expert-based consensus statement outlines key tenets of rehabilitative care including its multidisciplinary approach and discipline-specific guidance for occupational therapy, physical therapy, speech language pathology/therapy, and psychology/neuropsychology across all PD stages. CONCLUSIONS Rehabilitative interventions should be an essential component in the comprehensive treatment of PD, from diagnosis to advanced disease. Greater education and awareness of the benefits of rehabilitative services for people with PD and their care partners, and further evidence-based and scientific study are encouraged.
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Affiliation(s)
- Jennifer G Goldman
- JPG Enterprises LLC, Medical Division, Chicago, IL, USA
- ^Shirley Ryan AbilityLab, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Daniele Volpe
- Fresco Parkinson Institute, Fiesole, Italy
- Fresco Parkinson Center Villa Margherita, S. Stefano Riabilitazione, Vicenza, Italy
- NYU Grossman School of Medicine, New York, NY, USA
| | - Terry D Ellis
- Boston University Sargent College of Health and Rehabilitation Sciences, Boston, MA, USA
| | - Mark A Hirsch
- Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, Charlotte, NC, USA
| | - Julia Johnson
- Kings College Hospital NHS Foundation Trust, London, UK
| | - Julia Wood
- Lewy Body Dementia Association, Lilburn, GA, USA
| | - Ana Aragon
- Independent Consultant Occupational Therapist, Bath, UK
| | | | | | | | | | | | | | - Marten Munneke
- Radboudumc Center of Expertise for Movement Disorders, Nijmegen, Netherlands
| | - Serge Pinto
- The French National Centre for Scientific Research, Aix-Marseille University, Aix-en-Provence, France
| | | | - Santiago Toledo
- ^Shirley Ryan AbilityLab, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Ronnie Todaro
- Voz Advisors, New York, NY, USA
- ^Parkinson's Foundation, New York, NY, USA
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Cilia R, Dekker MCJ, Cubo E, Agoriwo MW. Delivery of Allied Health Therapies to People with Parkinson's Disease in Africa. JOURNAL OF PARKINSON'S DISEASE 2023:JPD230262. [PMID: 38143371 DOI: 10.3233/jpd-230262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
Allied health therapies refer to a range of healthcare professionals, including physiotherapists, occupational and speech-language therapists, who aim to optimize daily function and quality of life in conjunction with medical care. In this narrative review of literature on allied health therapies in people with Parkinson's disease (PD), we focused on the diversity in healthcare access, state of the art, current challenges in the African continent, and proposed solutions and future perspectives. Despite the increasing prevalence and awareness of PD in Africa, numerous challenges persist in its management. These include resource limitations, geographical barriers, sociocultural beliefs, and economic constraints. Nevertheless, innovative solutions, including telerehabilitation and community-based rehabilitation, offer hope. Collaborative efforts within the continent and internationally have shown potential in bridging training and resource gaps. Significant strides can be made with tailored interventions, technological advancements, and multifaceted collaborations. This review offers practical insights for healthcare professionals, policymakers, and caregivers to navigate and optimize PD care in the African context.
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Affiliation(s)
- Roberto Cilia
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Milan, Italy
| | - Marieke C J Dekker
- Department of Medicine and Pediatrics, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Esther Cubo
- Neurology Department, Hospital Universitario Burgos, Burgos, Spain
| | - Mary W Agoriwo
- Department of Physiotherapy and Rehabilitation Sciences, University of Health and Allied Sciences, Ho, Ghana
- Division of Physiotherapy, Stellenbosch University, Cape Town, South Africa
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Santos TB, de Moraes LGC, Pacheco PAF, dos Santos DG, Ribeiro RMDAC, Moreira CDS, da Rocha DR. Naphthoquinones as a Promising Class of Compounds for Facing the Challenge of Parkinson's Disease. Pharmaceuticals (Basel) 2023; 16:1577. [PMID: 38004442 PMCID: PMC10674926 DOI: 10.3390/ph16111577] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023] Open
Abstract
Parkinson's disease (PD) is a degenerative disease that affects approximately 6.1 million people and is primarily caused by the loss of dopaminergic neurons. Naphthoquinones have several biological activities explored in the literature, including neuroprotective effects. Therefore, this review shows an overview of naphthoquinones with neuroprotective effects, such as shikonin, plumbagin and vitamin K, that prevented oxidative stress, in addition to multiple mechanisms. Synthetic naphthoquinones with inhibitory activity on the P2X7 receptor were also found, leading to a neuroprotective effect on Neuro-2a cells. It was found that naphthazarin can act as inhibitors of the MAO-B enzyme. Vitamin K and synthetic naphthoquinones hybrids with tryptophan or dopamine showed inhibition of the aggregation of α-synuclein. Synthetic derivatives of juglone and naphthazarin were able to protect Neuro-2a cells against neurodegenerative effects of neurotoxins. In addition, routes for producing synthetic derivatives were also discussed. With the data presented, 1,4-naphthoquinones can be considered as a promising class in the treatment of PD and this review aims to assist the scientific community in the application of these compounds. The derivatives presented can also support further research that explores their structures as synthetic platforms, in addition to helping to understand the interaction of naphthoquinones with biological targets related to PD.
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Affiliation(s)
- Thaís Barreto Santos
- Instituto de Química, Universidade Federal Fluminense, Outeiro de São João Batista s/n°, Niterói CEP 24.020-141, RJ, Brazil; (T.B.S.); (L.G.C.d.M.); (P.A.F.P.); (D.G.d.S.); (R.M.d.A.C.R.); (C.d.S.M.)
| | - Leonardo Gomes Cavalieri de Moraes
- Instituto de Química, Universidade Federal Fluminense, Outeiro de São João Batista s/n°, Niterói CEP 24.020-141, RJ, Brazil; (T.B.S.); (L.G.C.d.M.); (P.A.F.P.); (D.G.d.S.); (R.M.d.A.C.R.); (C.d.S.M.)
| | - Paulo Anastácio Furtado Pacheco
- Instituto de Química, Universidade Federal Fluminense, Outeiro de São João Batista s/n°, Niterói CEP 24.020-141, RJ, Brazil; (T.B.S.); (L.G.C.d.M.); (P.A.F.P.); (D.G.d.S.); (R.M.d.A.C.R.); (C.d.S.M.)
| | - Douglas Galdino dos Santos
- Instituto de Química, Universidade Federal Fluminense, Outeiro de São João Batista s/n°, Niterói CEP 24.020-141, RJ, Brazil; (T.B.S.); (L.G.C.d.M.); (P.A.F.P.); (D.G.d.S.); (R.M.d.A.C.R.); (C.d.S.M.)
| | - Rafaella Machado de Assis Cabral Ribeiro
- Instituto de Química, Universidade Federal Fluminense, Outeiro de São João Batista s/n°, Niterói CEP 24.020-141, RJ, Brazil; (T.B.S.); (L.G.C.d.M.); (P.A.F.P.); (D.G.d.S.); (R.M.d.A.C.R.); (C.d.S.M.)
| | - Caroline dos Santos Moreira
- Instituto de Química, Universidade Federal Fluminense, Outeiro de São João Batista s/n°, Niterói CEP 24.020-141, RJ, Brazil; (T.B.S.); (L.G.C.d.M.); (P.A.F.P.); (D.G.d.S.); (R.M.d.A.C.R.); (C.d.S.M.)
- Instituto Federal do Rio de Janeiro, Campus Paracambi, Rua Sebastião Lacerda s/n°, Fábrica, Paracambi CEP 26.600-000, RJ, Brazil
| | - David Rodrigues da Rocha
- Instituto de Química, Universidade Federal Fluminense, Outeiro de São João Batista s/n°, Niterói CEP 24.020-141, RJ, Brazil; (T.B.S.); (L.G.C.d.M.); (P.A.F.P.); (D.G.d.S.); (R.M.d.A.C.R.); (C.d.S.M.)
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10
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Aamodt WW, Willis AW, Dahodwala N. Racial and Ethnic Disparities in Parkinson Disease: A Call to Action. Neurol Clin Pract 2023; 13:e200138. [PMID: 37064587 PMCID: PMC10101714 DOI: 10.1212/cpj.0000000000200138] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/01/2022] [Indexed: 03/18/2023]
Abstract
Health disparities are pervasive in the United States. In the field of Parkinson disease (PD), profound racial and ethnic disparities exist in diagnosis, treatment, and research participation, leading to differential health outcomes and lack of generalizable research data. Racial and ethnic disparities not only limit our understanding of this complex heterogeneous disorder but also hamper our ability to provide new evidence-based care for America's most vulnerable populations. In this report, we summarize findings from our comprehensive white paper for the Michael J. Fox Foundation that reviews the current state of knowledge on racial and ethnic disparities in PD care in the following areas: epidemiology, etiology, phenotype and diagnosis, treatment, and research. We also identify knowledge gaps and necessary policy changes to ensure equitable, high-value care for all persons with PD. These strategies are designed to help identify and reduce health disparities among persons with PD and may serve as a model for other neurologic diseases.
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Affiliation(s)
- Whitley W Aamodt
- Department of Neurology (WWA, AWW, ND); and Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research (WWA, AWW), University of Pennsylvania, Philadelphia, PA
| | - Allison W Willis
- Department of Neurology (WWA, AWW, ND); and Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research (WWA, AWW), University of Pennsylvania, Philadelphia, PA
| | - Nabila Dahodwala
- Department of Neurology (WWA, AWW, ND); and Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research (WWA, AWW), University of Pennsylvania, Philadelphia, PA
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11
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Sevitz JS, Borders JC, Dakin AE, Kiefer BR, Alcalay RN, Kuo SH, Troche MS. Rehabilitation of Airway Protection in Individuals With Movement Disorders: A Telehealth Feasibility Study. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2741-2758. [PMID: 36279509 PMCID: PMC9911128 DOI: 10.1044/2022_ajslp-22-00063] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/02/2022] [Accepted: 07/28/2022] [Indexed: 05/03/2023]
Abstract
PURPOSE Airway protective deficits (swallowing and cough) greatly reduce health and quality of life and are a pervasive consequence of neurodegenerative movement disorders. Expiratory muscle strength training (EMST) and cough skill training (CST) are two treatment approaches to improve airway protection; however, many patients are unable to access these treatments. Telehealth may improve access to care, but it remains unknown whether these treatments are feasible and efficacious via telehealth. This study aimed to determine the practical feasibility and preliminary treatment effect of EMST and CST via telehealth. METHOD Twenty participants with movement disorders completed 4 weeks of EMST and 2 weeks of CST, including two clinician-directed treatment sessions via telehealth and 3 days of home practice per week. Feasibility was calculated for each treatment. Practical feasibility was defined as completing treatment (EMST or CST) and obtaining the relevant outcome measures-a proxy of maximum expiratory pressure (pMEP) for EMST and peak expiratory flow rate (PEFR) for CST-within a 30-min session/period. Session factors that may have influenced feasibility were examined. Preliminary treatment effect was defined as changes in pMEP and PEFR. RESULTS Time taken to obtain pMEP and complete EMST was 17.48 min, and time taken to obtain PEFR and complete CST was 17.69 min. pMEP, single voluntary cough PEFR, and sequential voluntary cough PEFR increased from pre- to posttreatment. CONCLUSIONS Findings suggest that the delivery of EMST and CST is feasible via telehealth and yield improvements to pMEP and PEFR. This has important implications for expanding service delivery of airway protective interventions and reducing health care disparities in people with neurodegenerative movement disorders. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21357669.
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Affiliation(s)
- Jordanna S Sevitz
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - James C Borders
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Avery E Dakin
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Brianna R Kiefer
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
| | - Roy N Alcalay
- Department of Neurology, Columbia University Irving Medical Center, New York, NY
- Department of Neurology, Tel Aviv Sourasky Medical Center, Israel
| | - Sheng-Han Kuo
- Department of Neurology, Columbia University Irving Medical Center, New York, NY
| | - Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
- Department of Neurology, Columbia University Irving Medical Center, New York, NY
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12
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Richter RR, Chrusciel T, Salsich G, Austin T, Scherrer JF. Disparities Exist in Physical Therapy Utilization and Time to Utilization Between Black and White Patients With Musculoskeletal Pain. Phys Ther 2022; 102:6649124. [PMID: 35871435 DOI: 10.1093/ptj/pzac095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 01/24/2022] [Accepted: 04/05/2022] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Black patients are less likely than White patients to receive physical therapy for musculoskeletal pain conditions. Current evidence, however, is limited to self-reported conditions and health services use. The purpose of this study was to use a large electronic health record database to determine whether a race disparity existed in use of physical therapy within 90 days of a new musculoskeletal diagnosis. METHODS Eligible patients (n = 52,384) were sampled from an Optum deidentified electronic health record database of 5 million adults distributed throughout the United States. In this database, patients were designated as "Black" and "White." Patients were eligible if they had a new diagnosis for musculoskeletal neck, shoulder, back, or knee pain between January 1, 2012, and December 31, 2017. Logistic regression and Cox proportional hazard models were computed before and after adjusting for covariates to estimate the association between race and receipt of physical therapy services within 90 days of musculoskeletal pain diagnoses. RESULTS Patients were on average 47.5 (SD = 14.9) years of age, 12.8% were Black, 87.2% were White, and 52.7% were female. Ten percent of Black patients and 15.5% of White patients received physical therapy services within 90 days of musculoskeletal pain diagnoses. After adjusting for covariates, White patients were 57% more likely (odds ratio = 1.57; 95% CI = 1.44-1.71) to receive physical therapy compared with Black patients and had significantly shorter time to physical therapy than Black patients (hazard ratio = 1.53; 95% CI = 1.42-1.66). CONCLUSIONS In a nationally distributed cohort, Black patients were less likely than White patients to utilize physical therapy and had a longer time to utilization of physical therapy for musculoskeletal pain. IMPACT These findings highlight the need to determine the mechanisms underlying the observed disparities and how these disparities influence health outcomes.
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Affiliation(s)
- Randy R Richter
- Department of Physical Therapy and Athletic Training, Program in Physical Therapy, Doisy College of Health Sciences, Saint Louis University, St. Louis, Missouri, USA
| | - Timothy Chrusciel
- Department of Health and Clinical Outcomes Research, Salus Center, Saint Louis University School of Medicine, St. Louis, Missouri, USA.,Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA.,The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Gretchen Salsich
- Department of Physical Therapy and Athletic Training, Program in Physical Therapy, Doisy College of Health Sciences, Saint Louis University, St. Louis, Missouri, USA
| | - Tricia Austin
- Department of Physical Therapy and Athletic Training, Program in Physical Therapy, Doisy College of Health Sciences, Saint Louis University, St. Louis, Missouri, USA
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA.,The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, Missouri, USA
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13
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Physical Activity Coaching via Telehealth for People With Parkinson Disease: A Cohort Study. J Neurol Phys Ther 2022; 46:240-250. [PMID: 36170256 DOI: 10.1097/npt.0000000000000410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Physical activity (PA) has many known benefits for people with Parkinson disease (PD); however, many people do not meet recommended levels of frequency or intensity. We designed Engage-PD, a PA coaching program delivered via telehealth and grounded in self-determination theory to promote PA uptake and facilitate exercise self-efficacy in people with Parkinson disease. This study aimed to determine the feasibility and preliminary efficacy of Engage-PD, and to explore whether baseline characteristics were associated with outcomes. METHODS A single cohort of people with PD (n = 62, Hoehn and Yahr I-III) participated in the 3-month Engage-PD program, which consisted of up to 5 telehealth coaching sessions delivered by physical therapists. Feasibility was evaluated based on recruitment and retention rates, along with participants' feedback. Planned and unplanned PA, exercise self-efficacy (ESE), and individualized goals were assessed pre- and post-intervention. Relationships between baseline characteristics and changes in planned PA and ESE were also evaluated. RESULTS Recruitment (62%) and retention (85%) rates were high, and the intervention was well accepted and perceived by the participants. From pre- to postintervention, participants increased planned PA (d = 0.33), ESE (d = 1.20), and individualized goal performance (d = 1.63) and satisfaction (d = 1.70). Participants with lower baseline planned PA experienced greater improvements in planned PA, and those with lower baseline ESE experienced greater improvements in ESE. DISCUSSION AND CONCLUSIONS A telehealth PA coaching program for people with PD was feasible and potentially efficacious. Physical therapist-led coaching may be an important component of a consultative model of care starting early in the disease process.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A393).
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14
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Fulk G. JNPT and Representation. J Neurol Phys Ther 2022; 46:229-230. [PMID: 35939366 DOI: 10.1097/npt.0000000000000420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Occupational Therapy for People with Early Parkinson’s Disease: A Retrospective Program Evaluation. PARKINSON'S DISEASE 2022; 2022:1931468. [PMID: 35873703 PMCID: PMC9300278 DOI: 10.1155/2022/1931468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 04/07/2022] [Accepted: 06/02/2022] [Indexed: 11/30/2022]
Abstract
Purpose Clinical practice guidelines establish that occupational therapy (OT) services are indicated for people with early Parkinson's disease (PD). However, OT is uncommon compared to other rehabilitation services. This study describes the development and evaluation of a proactive, consultative OT program for people with early PD as a part of an integrated care approach. Materials and Methods The program was developed by an occupational therapist adapting practice guidelines for people with early PD. Retrospective program evaluation occurred at an outpatient rehabilitation clinic. The consultative OT program for early PD includes a 90-minute evaluation with instruction in self-management techniques, individually tailored exercises, and follow-up recommendations. The program was evaluated with the RE-AIM framework. Postprogram semistructured interviews provided patient-reported program effectiveness and satisfaction. Results In 2018, 23 individuals used OT out of 77 people with early PD who attended the proactive rehabilitation program. Most individuals (n = 16, 69.6%) were within Hoehn and Yahr stages 1-2 and were seen within 3 years of PD diagnosis. Participants presented with deficits in hand strength (60.0 ± 23.4 pounds) and dexterity (right hand 30.0 ± 8.0 seconds) and reported complaints about basic and/or instrumental activities of daily living (n = 15, 65.2%). Semistructured interviews (n = 16) revealed that most individuals (75%) reported high satisfaction. Of the 10 who recalled a home exercise program, 60% reported continued adherence. Consultative OT was delivered with fidelity in 22/23 individuals (96%). After one year, only two occupational therapists at one clinic had adopted the program, and the program is maintained in the organization. Conclusion Occupational therapists reached people in the early stages of PD when a specific program was tailored to evaluate and target their specific needs. Motor activity deficits noted in individuals with early PD support future scaling and sustainability efforts of OT within this population. Quality improvement suggestions are discussed for future implementation and clinical trials.
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16
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LRRK2 and Proteostasis in Parkinson's Disease. Int J Mol Sci 2022; 23:ijms23126808. [PMID: 35743250 PMCID: PMC9224256 DOI: 10.3390/ijms23126808] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 02/01/2023] Open
Abstract
Parkinson’s disease is a neurodegenerative condition initially characterized by the presence of tremor, muscle stiffness and impaired balance, with the deposition of insoluble protein aggregates in Lewy’s Bodies the histopathological hallmark of the disease. Although different gene variants are linked to Parkinson disease, mutations in the Leucine-Rich Repeat Kinase 2 (LRRK2) gene are one of the most frequent causes of Parkinson’s disease related to genetic mutations. LRRK2 toxicity has been mainly explained by an increase in kinase activity, but alternative mechanisms have emerged as underlying causes for Parkinson’s disease, such as the imbalance in LRRK2 homeostasis and the involvement of LRRK2 in aggregation and spreading of α-synuclein toxicity. In this review, we recapitulate the main LRRK2 pathological mutations that contribute to Parkinson’s disease and the different cellular and therapeutic strategies devised to correct LRRK2 homeostasis. In this review, we describe the main cellular control mechanisms that regulate LRRK2 folding and aggregation, such as the chaperone network and the protein-clearing pathways such as the ubiquitin–proteasome system and the autophagic-lysosomal pathway. We will also address the more relevant strategies to modulate neurodegeneration in Parkinson’s disease through the regulation of LRRK2, using small molecules or LRRK2 silencing.
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17
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Wood J, Henderson W, Foster ER. Occupational Therapy Practice Guidelines for People With Parkinson's Disease. Am J Occup Ther 2022; 76:23280. [PMID: 35648119 DOI: 10.5014/ajot.2022.763001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Occupational therapy practitioners address the occupational performance and participation needs of people with Parkinson's disease (PD) and their care partners. OBJECTIVE This Practice Guideline is informed by systematic reviews on the use of occupational therapy interventions to promote participation in occupations for people with PD and to facilitate their caregivers' participation in the caregiver role. This guideline is meant to support practitioners' clinical decision making when working with people with PD and their care partners. METHOD We examined and synthesized the results of four systematic reviews and integrated those results into clinical recommendations for practice. RESULTS Thirty-three articles from the systematic reviews served as the basis for the clinical recommendations in this Practice Guideline. Clinical recommendations are provided for interventions that have strong or moderate supporting evidence. CONCLUSION AND RECOMMENDATIONS Multidisciplinary, tailored, goal-oriented intervention is recommended for people with PD. Various forms of exercise can be used to improve activities of daily living and instrumental activities of daily living performance and social participation, and interventions should incorporate health behavior change techniques to support adequate physical activity levels in daily life. Mindfulness meditation and exercise can be used to support sleep, and task-oriented training can be used to improve performance of specific tasks. Occupational therapy practitioners should incorporate self-management, coaching, compensatory, cognitive-behavioral, and other approaches into multicomponent treatment plans depending on the client's needs and goals. Additional potentially appropriate intervention approaches or areas to address are discussed on the basis of existing or emerging evidence and expert opinion. What This Article Adds: This Practice Guideline provides a summary and applications of the current evidence supporting occupational therapy intervention for people with PD. It includes case examples and suggested decision-making algorithms to support practitioners in addressing client goals.
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Affiliation(s)
- Julia Wood
- Julia Wood, MOT, OTR/L, is Director of Professional and Community Education, Lewy Body Dementia Association, Lilburn, GA;
| | - Whitney Henderson
- Whitney Henderson, OTD, MOT, OTR/L, is Associate Clinical Professor in Occupational Therapy, University of Missouri, Columbia
| | - Erin R Foster
- Erin R. Foster, PhD, OTD, OTR/L, is Associate Professor in Occupational Therapy, Neurology and Psychiatry, Washington University School of Medicine, St. Louis, MO
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18
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Coelho M. Race as one for Parkinson's disease. Parkinsonism Relat Disord 2022; 96:98-99. [DOI: 10.1016/j.parkreldis.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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19
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Bailey M, Anderson S, Stebbins G, Barnes L, Shulman LM, Tartakovsky J, Hall DA. Comparison of motor, non-motor, and quality of life phenotype in Black and White patients with Parkinson's disease. Parkinsonism Relat Disord 2022; 96:18-21. [DOI: 10.1016/j.parkreldis.2022.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 01/10/2022] [Accepted: 01/17/2022] [Indexed: 12/01/2022]
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20
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Osborne JA, Botkin R, Colon-Semenza C, DeAngelis TR, Gallardo OG, Kosakowski H, Martello J, Pradhan S, Rafferty M, Readinger JL, Whitt AL, Ellis TD. Physical Therapist Management of Parkinson Disease: A Clinical Practice Guideline From the American Physical Therapy Association. Phys Ther 2021; 102:6485202. [PMID: 34963139 PMCID: PMC9046970 DOI: 10.1093/ptj/pzab302] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/04/2022] [Indexed: 11/16/2022]
Abstract
A clinical practice guideline on Parkinson disease was developed by an American Physical Therapy Association volunteer guideline development group that consisted of physical therapists and a neurologist. The guideline was based on systematic reviews of current scientific and clinical information and accepted approaches for management of Parkinson disease. The Spanish version of this clinical practice guideline is available as a supplement (Suppl. Appendix 1).
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Affiliation(s)
- Jacqueline A Osborne
- Brooks Rehabilitation Hospital, Brooks Institute of Higher Learning, Jacksonville, Florida, USA
| | - Rachel Botkin
- Botkin Rehab Services, Physical Therapy, Columbus, Ohio, USA
| | - Cristina Colon-Semenza
- Department of Kinesiology, Doctor of Physical Therapy Program, University of Connecticut, Storrs, Connecticut, USA
| | - Tamara R DeAngelis
- Boston University Sargent College of Health and Rehabilitation Services, Physical Therapy and Athletic Training, Boston, Massachusetts, USA
| | - Oscar G Gallardo
- Rancho Los Amigos National Rehabilitation Center, Physical Therapy, Downey, California, USA
| | - Heidi Kosakowski
- Address all correspondence to Dr Kosakowski care of the Department of Practice of the American Physical Therapy Association at:
| | | | - Sujata Pradhan
- University of Washington, Rehabilitation Medicine, Seattle, Washington, USA
| | - Miriam Rafferty
- Northwestern University, Center for Education in Health Sciences, Chicago, Illinois, USA
| | | | | | - Terry D Ellis
- Boston University Sargent College of Health and Rehabilitation Services, Physical Therapy and Athletic Training, Boston, Massachusetts, USA
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21
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Barrett MJ, Sargent L, Nawaz H, Weintraub D, Price ET, Willis AW. Antimuscarinic Anticholinergic Medications in Parkinson Disease: To Prescribe or Deprescribe? Mov Disord Clin Pract 2021; 8:1181-1188. [PMID: 34765683 DOI: 10.1002/mdc3.13347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/10/2021] [Accepted: 08/17/2021] [Indexed: 12/13/2022] Open
Abstract
The relative importance of antimuscarinic anticholinergic medications for Parkinson's disease (PD) declined after the introduction of levodopa, such that anticholinergic medications are now much more likely to be prescribed for clinical indications other than parkinsonism. Recent studies have found an association between anticholinergic medication exposure and future risk of dementia in older individuals and those with PD. These findings provide a further reason to avoid the use of anticholinergic medications to treat motor symptoms of PD. More importantly, they raise the question of whether one of the goals of PD treatment should be to deprescribe all medications with anticholinergic properties, regardless of their indication, to reduce dementia risk. In this review, we discuss the use of anticholinergic medications in PD, the evidence supporting the association between anticholinergic medications and future dementia risk, and the potential implications of these findings for clinical care in PD.
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Affiliation(s)
- Matthew J Barrett
- Department of Neurology Virginia Commonwealth University Richmond Virginia USA
| | - Lana Sargent
- School of Nursing Virginia Commonwealth University Richmond Virginia USA.,Department of Pharmacotherapy and Outcomes Science, School of Pharmacy Virginia Commonwealth University Richmond Virginia USA.,Geriatric Pharmacotherapy Program, School of Pharmacy Virginia Commonwealth University Richmond Virginia USA.,Institute for Inclusion Inquiry and Innovation (iCubed): Health and Wellness in Aging Populations Core Richmond Virginia USA
| | - Huma Nawaz
- Department of Neurology Virginia Commonwealth University Richmond Virginia USA
| | - Daniel Weintraub
- Department of Neurology University of Pennsylvania School of Medicine Philadelphia Pennsylvania USA.,Parkinson's Disease Research, Education and Clinical Center Corporal Michael J. Crescenz VA Medical Center Philadelphia Pennsylvania USA.,Department of Psychiatry University of Pennsylvania School of Medicine Philadelphia Pennsylvania USA
| | - Elvin T Price
- Department of Pharmacotherapy and Outcomes Science, School of Pharmacy Virginia Commonwealth University Richmond Virginia USA.,Geriatric Pharmacotherapy Program, School of Pharmacy Virginia Commonwealth University Richmond Virginia USA.,Institute for Inclusion Inquiry and Innovation (iCubed): Health and Wellness in Aging Populations Core Richmond Virginia USA
| | - Allison W Willis
- Department of Neurology University of Pennsylvania School of Medicine Philadelphia Pennsylvania USA.,Center for Pharmacoepidemiology Research and Training, Department of Epidemiology University of Pennsylvania School of Medicine Philadelphia Pennsylvania USA.,Department of Biostatistics, Epidemiology and Informatics University of Pennsylvania School of Medicine Philadelphia Pennsylvania USA
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22
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Sustainment of proactive physical therapy for individuals with early-stage Parkinson's disease: a quality improvement study over 4 years. Implement Sci Commun 2021; 2:111. [PMID: 34579790 PMCID: PMC8477476 DOI: 10.1186/s43058-021-00205-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 08/25/2021] [Indexed: 11/23/2022] Open
Abstract
Background Implementation science frameworks aided the development of a new, evidence-based clinical physical therapy program. The purpose of this report is to describe the process of sustaining a clinical program in practice for over 4 years. We present a framework for integrating tools for sustainability with the Knowledge-to-Action model in the context of a proactive physical therapy (PAPT) program for individuals with early-stage Parkinson’s disease. Methods Sustainability of implementation strategies was addressed using the Dynamic Sustainability Framework and sustainability assessment tools. Repeated retrospective medical record reviews and phone interviews were used to evaluate the reach and adoption of the PAPT over 4 years. Characteristics of those who engaged with PAPT, implementation fidelity, and clinical effectiveness were assessed for year 1 and year 3. Sustainability was measured using RE-AIM, NHS Sustainability Model, and Clinical Sustainability Assessment Tool. Results Reach increased from 28 to 110 total patients per year and spread occurred from one to three sites. PAPT user age, sex, Hoehn and Yahr rating, time since diagnosis, and type of insurance were similar in year 1 and year 3 (p > 0.05). The program sustained its effect to help participants increase or maintain self-reported exercise (Y1, 95%; Y3, 100%). However, upon evaluation PAPT users in year 3 had longer time since symptom onset and worse UPDRS motor scores compared to the PAPT users in year 1 (p < 0.05). All sites sustained the core intervention components, with sustainability scores of 71/100 (± 9.9) on the NHS Sustainability Model and 6.1/7 (± 0.9) on the Clinical Sustainability Assessment Tool. Conclusions Integrating multiple sustainability models and assessments supported continued effectiveness, spread, and sustainment of PAPT for 4 years. Effective planning, anticipating common healthcare changes, and addressing sustainability determinants early in program implementation were essential aspects of long-term success. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-021-00205-x.
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Kim DS, Kunicki ZJ, Philips OW, Jones RN, Friedman JH, Kluger B, Akbar U. Racial and geographic disparities with gastrostomy tube placement in dementia and parkinsonian disorders. Parkinsonism Relat Disord 2021; 91:28-31. [PMID: 34479055 DOI: 10.1016/j.parkreldis.2021.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Many patients with advanced dementia and Parkinson's disease and related disorders (PDRD) are receiving gastrostomy tube (GT) placement annually, despite its lack of proven benefit for preventing aspiration, enhancing nutrition, or prolonging survival. Given clinical practice variability in the care of people with neurodegenerative disorders, we sought to examine racial and geographic disparities in GT placement for these populations in the United States. METHOD Data were extracted from a publicly-available national database using diagnostic and procedural codes from 2006 to 2010. GT placement rates and odds ratios were calculated for two groups: PDRD and non-parkinsonian dementia (NPD). RESULTS In the PDRD group, odds of GT placement were higher among patients coded as Black (OR 1.69, CI 0.80-3.56, p = 0.17) and Asian (OR 2.17, CI 0.70-6.78, p = 0.18) than Whites; although these tendencies did not reach statistical significance. In the NPD group, GT placement among Black patients was significantly more likely (OR 2.88, CI 1.90-4.36, p < 0.001) than their white counterparts, while Asian patients were significantly less likely (OR 0.12, CI 0.02-0.91, p = 0.04). Compared to the Northeast region, there were significantly lower odds of GT placement in the Midwest region (OR 0.37, CI 0.24-0.58, p < 0.001) in the NPD group only. No difference in odds was observed between the sexes in both groups. CONCLUSION This study showed geographic and racial disparities in GT placement among PDRD and NPD patients. Further studies should aim to clarify best practices for GT placement in PDRD and causes of practice differences within and between PDRD and NPD groups.
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Affiliation(s)
- Duk Soo Kim
- Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI, USA; Rhode Island Hospital, Providence, RI, USA
| | - Zachary J Kunicki
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Oliver W Philips
- Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI, USA; Rhode Island Hospital, Providence, RI, USA
| | - Richard N Jones
- Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Joseph H Friedman
- Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI, USA; Butler Hospital, Providence, RI, USA
| | - Benzi Kluger
- Department of Neurology, University of Rochester, Rochester, NY, USA
| | - Umer Akbar
- Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI, USA; Rhode Island Hospital, Providence, RI, USA; Butler Hospital, Providence, RI, USA.
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Bailey M, Anderson S, Hall DA. Parkinson's Disease in African Americans: A Review of the Current Literature. JOURNAL OF PARKINSONS DISEASE 2021; 10:831-841. [PMID: 32417794 PMCID: PMC7458499 DOI: 10.3233/jpd-191823] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Parkinson’s disease (PD) is the second most common neurodegenerative disease, though evidence suggests that this disorder does not affect all racial groups similarly. Research in African Americans, in particular, has been conflicting. Some studies have found similar prevalence rates in African Americans and whites whereas other studies have found much lower prevalence and incidence rates in African Americans. A few studies identify potential factors underlying these discrepancies, including biologic differences as well as disparities in healthcare access. However, African Americans remain underrepresented in research studies, which make understanding the underlying reasons for these differences difficult. The purpose of this paper is to summarize existing research in African Americans with PD, highlight some of the reasons why differences exist in diagnostic rates of PD in this population, and briefly discuss interventions that may need to be made in order to ensure adequate care is provided to these patients.
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Affiliation(s)
- Meagan Bailey
- Rush University Medical Center Department of Neurological Sciences, Chicago, IL, USA
| | - Sharlet Anderson
- Rush University Medical Center Department of Neurological Sciences, Chicago, IL, USA
| | - Deborah A Hall
- Rush University Medical Center Department of Neurological Sciences, Chicago, IL, USA
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25
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Yun SJ, Seo HG. Changes in Epidemiological Trends and Rehabilitation Usage in Neurological Diseases in Korea: Parkinson's Disease. BRAIN & NEUROREHABILITATION 2021; 14:e12. [PMID: 36743428 PMCID: PMC9879503 DOI: 10.12786/bn.2021.14.e12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/11/2021] [Accepted: 07/14/2021] [Indexed: 11/08/2022] Open
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder characterized by typical motor symptoms such as resting tremor, bradykinesia, and rigidity, as well as non-motor manifestations, including psychiatric symptoms, autonomic dysfunction, and cognitive impairment. These symptoms induce a marked impact on functional independence in daily activities and quality of life in PD patients. Recent guidelines recommend adequate rehabilitation education and treatment from the early stages of PD, and rehabilitation has become part of standard care for PD. In Korea, the number of patients with PD has more than tripled over 15 years, from 39,265 in 2004 to 125,607 in 2019. However, the rehabilitation usage of PD patients has not changed remarkably, and it remains suboptimal in Korea compared to several developed countries, which have advanced and disseminated guidelines and implemented specialized care delivery systems for PD over the past 20 years. Additional efforts are warranted to provide adequate rehabilitation therapies for PD patients in Korea.
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Affiliation(s)
- Seo Jung Yun
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
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26
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Bailey M, Shulman LM, Ryan D, Ouyang B, Shulman JM, Buchman AS, Bennett DA, Barnes LL, Hall DA. Frequency of Parkinsonism and Parkinson Disease in African Americans in the Chicago Community. J Gerontol A Biol Sci Med Sci 2021; 76:1340-1345. [PMID: 33631006 PMCID: PMC8202152 DOI: 10.1093/gerona/glab042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There is paucity of data about African American (AA) patients with Parkinson's disease (PD) and parkinsonism which may precede PD in older adults. Prior studies suggest that there are lower rates of PD in the AA population, with more cognitive impairment in AA with PD. This study aimed to investigate differences in PD, parkinsonism, and cognition between White and AA populations in 3 longitudinal epidemiologic cohort studies of aging. METHODS This study examined parkinsonism, PD frequency, and cognition of community-dwelling older individuals in 3 longitudinal epidemiologic cohort studies. Parkinsonism was based on an exam utilizing the modified Unified Parkinson's Disease Rating Scale performed by a nurse. PD was based on self-report, medications used for treatment of PD, and examination findings. Cognition was assessed using 19 performance-based tests that assess 5 cognitive domains. RESULTS AA participants were less likely to have parkinsonism compared to Whites, even with age and gender differences. Frequency of PD was not significant between groups. AA were more likely to have lower cognitive scores as compared to Whites. AA were less likely to have parkinsonism even with controlling for cognitive differences between groups. CONCLUSIONS Parkinsonian signs are present among AA in the community at lower rates than in White individuals. Cognitive profiles of AA and Whites with parkinsonism may be different, suggesting differing contributions of pathology to cognitive decline and parkinsonism between groups. Additional research is needed to understand the progression of parkinsonism to PD, as well as to understanding the cognitive differences in AA with parkinsonism.
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Affiliation(s)
- Meagan Bailey
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Lisa M Shulman
- Department of Neurology, University of Maryland School of Medicine, Baltimore, USA
| | - Diane Ryan
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Bichun Ouyang
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Joshua M Shulman
- Department of Neurology, Baylor College of Medicine and Jan and Dan Duncan Neurological Research Institute, Houston, Texas, USA
| | - Aron S Buchman
- Department of Neurological Sciences, Rush Alzheimer’s Disease Center, Chicago, Illinois, USA
| | - David A Bennett
- Department of Neurological Sciences, Rush Alzheimer’s Disease Center, Chicago, Illinois, USA
| | - Lisa L Barnes
- Department of Neurological Sciences, Rush Alzheimer’s Disease Center, Chicago, Illinois, USA
| | - Deborah A Hall
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
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Abstract
Parkinson's disease is a recognisable clinical syndrome with a range of causes and clinical presentations. Parkinson's disease represents a fast-growing neurodegenerative condition; the rising prevalence worldwide resembles the many characteristics typically observed during a pandemic, except for an infectious cause. In most populations, 3-5% of Parkinson's disease is explained by genetic causes linked to known Parkinson's disease genes, thus representing monogenic Parkinson's disease, whereas 90 genetic risk variants collectively explain 16-36% of the heritable risk of non-monogenic Parkinson's disease. Additional causal associations include having a relative with Parkinson's disease or tremor, constipation, and being a non-smoker, each at least doubling the risk of Parkinson's disease. The diagnosis is clinically based; ancillary testing is reserved for people with an atypical presentation. Current criteria define Parkinson's disease as the presence of bradykinesia combined with either rest tremor, rigidity, or both. However, the clinical presentation is multifaceted and includes many non-motor symptoms. Prognostic counselling is guided by awareness of disease subtypes. Clinically manifest Parkinson's disease is preceded by a potentially long prodromal period. Presently, establishment of prodromal symptoms has no clinical implications other than symptom suppression, although recognition of prodromal parkinsonism will probably have consequences when disease-modifying treatments become available. Treatment goals vary from person to person, emphasising the need for personalised management. There is no reason to postpone symptomatic treatment in people developing disability due to Parkinson's disease. Levodopa is the most common medication used as first-line therapy. Optimal management should start at diagnosis and requires a multidisciplinary team approach, including a growing repertoire of non-pharmacological interventions. At present, no therapy can slow down or arrest the progression of Parkinson's disease, but informed by new insights in genetic causes and mechanisms of neuronal death, several promising strategies are being tested for disease-modifying potential. With the perspective of people with Parkinson's disease as a so-called red thread throughout this Seminar, we will show how personalised management of Parkinson's disease can be optimised.
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Affiliation(s)
- Bastiaan R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson and Movement Disorders, Nijmegen, Netherlands.
| | - Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Christine Klein
- Institute of Neurogenetics and Department of Neurology, University of Lübeck and University Hospital Schleswig-Holstein, Lübeck, Germany
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28
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Braaten AD, Hanebuth C, McPherson H, Smallwood D, Kaplan S, Basirico D, Clewley D, Rethorn Z. Social determinants of health are associated with physical therapy use: a systematic review. Br J Sports Med 2021; 55:1293-1300. [PMID: 34083223 DOI: 10.1136/bjsports-2020-103475] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The purpose of this systematic review is to identify and summarise the social determinants of health (SDH) cited in the literature and evaluate their association with individuals using physical therapy services. DESIGN A systematic review using qualitatively synthesised information to describe the association between SDH and physical therapy use. DATA SOURCES The electronic databases Medline, Embase and Scopus were searched from inception to February 2021, identifying observational and qualitative studies. ELIGIBILITY CRITERIA Published studies included all adults, aged 18 or older, who independently sought to use physical therapy, in all practice settings from all geographical locations. RESULTS Of the 9248 studies screened, 36 met the inclusion criteria for the review. The participants represented 8 countries and totaled 2 699 437. The majority of the papers reported moderate strength of association for each SDH. Female gender, non-Hispanic white race/ethnicity, increased education attainment, urban environment, access to transportation, employment, high socioeconomic status and private insurance were associated with higher likelihood of physical therapy use. CONCLUSION This systematic review identifies predisposing and enabling factors impacting physical therapy usage among adults in different countries and across physical therapy settings. The results of this study have implications for policy and future research regarding populations that have been shown to be using physical therapy services less, such as those with lower levels of education, those in a rural area, or those in a low socioeconomic class.
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Affiliation(s)
- Amanda Day Braaten
- Doctor of Physical Therapy, Duke University Division of Orthopaedic Surgery, Durham, North Carolina, USA
| | - Cannon Hanebuth
- Doctor of Physical Therapy, Duke University Division of Orthopaedic Surgery, Durham, North Carolina, USA
| | - Holt McPherson
- Doctor of Physical Therapy, Duke University Division of Orthopaedic Surgery, Durham, North Carolina, USA
| | - Dashae Smallwood
- Doctor of Physical Therapy, Duke University Division of Orthopaedic Surgery, Durham, North Carolina, USA
| | - Samantha Kaplan
- Medical Center Library & Archives, Duke University, Durham, North Carolina, USA
| | - David Basirico
- Doctor of Physical Therapy, Duke University Division of Orthopaedic Surgery, Durham, North Carolina, USA
| | - Derek Clewley
- Doctor of Physical Therapy, Duke University Division of Orthopaedic Surgery, Durham, North Carolina, USA
| | - Zachary Rethorn
- Doctor of Physical Therapy, Duke University Division of Orthopaedic Surgery, Durham, North Carolina, USA
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29
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Ellis TD, Colón-Semenza C, DeAngelis TR, Thomas CA, Hilaire MHS, Earhart GM, Dibble LE. Evidence for Early and Regular Physical Therapy and Exercise in Parkinson's Disease. Semin Neurol 2021; 41:189-205. [PMID: 33742432 DOI: 10.1055/s-0041-1725133] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Advances in medical management of Parkinson's disease (PD) have resulted in living longer with disability. Although disability worsens over the course of the disease, there are signs of disability even in the early stages. Several studies reveal an early decline in gait and balance and a high prevalence of nonmotor signs in the prodromal period that contribute to early disability. There is a growing body of evidence revealing the benefits of physical therapy and exercise to mitigate motor and nonmotor signs while improving physical function and reducing disability. The presence of early disability coupled with the benefits of exercise suggests that physical therapy should be initiated earlier in the disease. In this review, we present the evidence revealing early disability in PD and the effectiveness of physical therapy and exercise, followed by a discussion of a secondary prevention model of rehabilitation to reduce early disability and optimize long-term outcomes.
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Affiliation(s)
- Terry D Ellis
- Department of Physical Therapy and Athletic Training, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, Massachusetts
| | - Cristina Colón-Semenza
- Center for Neurorehabilitation, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, Massachusetts
| | - Tamara R DeAngelis
- Center for Neurorehabilitation, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, Massachusetts
| | - Cathi A Thomas
- Parkinson's Disease and Movement Disorders Center, Boston University Medical Campus, Boston, Massachusetts.,American Parkinson Disease Association Information and Referral Center at Boston University Medical Center, Boston, Massachusetts
| | - Marie-Hélène Saint Hilaire
- Parkinson's Disease and Movement Disorders Center, Boston University Medical Campus, Boston, Massachusetts.,Department of Neurology at Boston University School of Medicine, Boston, Massachusetts.,American Parkinson Disease Association Center for Advanced Research at Boston University Medical Center, Boston, Massachusetts
| | - Gammon M Earhart
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Leland E Dibble
- Department of Physical Therapy and Athletic Training, The University of Utah, Salt Lake City, Utah.,Health-Kinesiology-Recreation, The University of Utah, Salt Lake City, Utah
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30
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Schwartz AE, Munsell EGS, Schmidt EK, Colón-Semenza C, Carolan K, Gassner DL. Impact of COVID-19 on services for people with disabilities and chronic health conditions. Disabil Health J 2021; 14:101090. [PMID: 33715986 DOI: 10.1016/j.dhjo.2021.101090] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/18/2021] [Accepted: 02/20/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND People with disabilities and chronic health conditions rely on a range of services and supports to complete daily tasks, maintain health, and participate in the community. Preliminary research suggests the COVID-19 pandemic greatly disrupted these services and this population may be particularly susceptible to unemployment. OBJECTIVE Describe employment and service disruptions for individuals with disabilities and chronic health conditions during the onset of community-based spread of COVID-19 in the United States. METHODS Adults with disabilities and chronic health conditions completed online surveys to report employment and service changes via multiple choice and open-ended questions. Multiple choice questions were analyzed using descriptive statistics; open-ended responses were coded using content analysis. RESULTS Participants (n = 109): 79.8% female, 88.1% white, 77.121% completed a 4-year college degree or greater, 61.4% had annual income ≥$45,000. Only 14.9% of survey respondents reported disruptions in employment. On average, 54.0% of service changes were due to discontinuation, including loss of physical therapy, job coaching, community organizations, transportation, and peer supports. Other changes included a shift to virtual service delivery and family members taking the role of service providers. CONCLUSIONS Individuals with chronic health conditions and disabilities experienced service disruptions, even in a sample with considerably more economic, social, and educational privilege than the general population of people with chronic health conditions and disabilities in the United States.
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Affiliation(s)
- Ariel E Schwartz
- Boston University Center for Psychiatric Rehabilitation, 940 Commonwealth Avenue, Boston, MA, 02215, USA.
| | - Elizabeth G S Munsell
- Boston University, College of Health and Rehabilitation Sciences: Sargent College, 635 Commonwealth Ave, Boston, MA, 02215, USA.
| | - Elizabeth K Schmidt
- Boston University, College of Health and Rehabilitation Sciences: Sargent College, 635 Commonwealth Ave, Boston, MA, 02215, USA.
| | - Cristina Colón-Semenza
- University of Connecticut, Kinesiology Department, Doctor of Physical Therapy Program, 3107 Horsebarn Hill Road, Storrs, CT, 06269, USA.
| | - Kelsi Carolan
- University of Connecticut School of Social Work, 38 Prospect Street, Hartford, CT, 06103, USA.
| | - Dena L Gassner
- Adjunct Faculty Towson University, Adelphi University, USA.
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Slater LV, Gebska A, McCartney K, Rafferty MR. Designing a screening battery for exercisers with Parkinson's disease. Disabil Rehabil 2021; 44:4111-4117. [PMID: 33645370 DOI: 10.1080/09638288.2021.1883748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Develop a screening battery for persons with Parkinson's Disease (PD) that is easily administered in a short amount of time by community exercise professionals and measures changes in function. METHODS An integrated, stakeholder-engaged, mixed methods approach included interviews and meetings with community exercise professionals on the development of a screening battery. Persons with PD (n = 57, age = 72.1 ± 8.1 years) who were already enrolled in fitness classes or individualized training at three locations participated in the screening battery twice over 8-16 weeks and provided feedback. Trends from interviews and meeting notes were identified using summative content analysis. Quantitative changes in performance were compared with paired t-tests. Cohen's d effect sizes were calculated for all significant differences. RESULTS Current barriers for functional screenings included time and space. Using this feedback, we developed a screening battery that took under 20 min, required little equipment, had been previously validated, could be performed in individual and group settings, and provided objective feedback that was motivating for persons with PD to continue exercising. Persons with PD demonstrated improved functional performance on sit-to-stand (d = -0.71), two-minute walk test (d = -3.83), and arm curls (d = -0.78). CONCLUSION Test results can be a motivator for persons with PD and lead to increased exercise adherence. Easily administered tests can show improvements in this population. Community exercise professionals are able to safely screen persons with PD to detect functional deficits and assist with programming.Implications for RehabilitationRegular exercise can slow declines in physical function and quality of life in people with Parkinson's disease.Use of physical assessments in community exercise programs can improve motivation to exercise for this population.Physical assessments such as sit-to-stand and arm curls can be used to demonstrate improvements in people with Parkinson's disease.
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Affiliation(s)
- Lindsay V Slater
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | | | | | - Miriam R Rafferty
- Shirley Ryan AbilityLab, Chicago, IL, USA.,Department of Physical Rehabilitation and Medicine, Northwestern University, Chicago, IL, USA
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32
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Rafferty MR, Nettnin E, Goldman JG, MacDonald J. Frameworks for Parkinson's Disease Rehabilitation Addressing When, What, and How. Curr Neurol Neurosci Rep 2021; 21:12. [PMID: 33615420 PMCID: PMC8215896 DOI: 10.1007/s11910-021-01096-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW This review summarizes the evidence on rehabilitation for people with Parkinson's disease, including when to refer, what rehabilitation professionals should address, and how to deliver rehabilitation care. RECENT FINDINGS Clinical practice guidelines support physical therapy, occupational therapy, and speech-language pathology for Parkinson's disease. However, integrating guidelines into practice may be difficult. Implementation studies take into account patient and clinician perspectives. Synthesizing guidelines with implementation research can improve local delivery. There is moderate to strong evidence supporting physical therapy, occupational therapy, and speech-language pathology soon after diagnosis and in response to functional deficits. We propose a framework of three pathways for rehabilitation care: (1) consultative proactive rehabilitation soon after diagnosis for assessment, treatment of early deficits, and promotion meaningful activities; (2) restorative rehabilitation to promote functional improvements; and (3) skilled maintenance rehabilitation for long-term monitoring of exercise, meaningful activities, safety, contractures, skin integrity, positioning, swallowing, and communication.
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Affiliation(s)
- Miriam R Rafferty
- Shirley Ryan AbilityLab, Chicago, IL, USA.
- Departments of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Department of Psychiatry and Behavioral Science, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | | | - Jennifer G Goldman
- Shirley Ryan AbilityLab, Chicago, IL, USA
- Departments of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Roberts AC, Rafferty MR, Wu SS, Miao G, Cubillos F, Simuni T. Patterns and predictors of referrals to allied health services for individuals with Parkinson's disease: A Parkinson's foundation (PF) QII study. Parkinsonism Relat Disord 2020; 83:115-122. [PMID: 33339716 DOI: 10.1016/j.parkreldis.2020.11.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/27/2020] [Accepted: 11/25/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Rehabilitation therapies are critical for optimizing quality-of-life and daily functions for individuals living with Parkinson's disease (PD). Thus, understanding the patterns of and under what conditions physicians make rehabilitation referrals is important for optimizing care. METHOD We analyzed data from 5020 participants (4 countries) collected from 1/3/2016 to 4/20/2018 as part of the Parkinson's Foundation Quality Improvement Initiative (PF QII). Data were analyzed for single discipline and multidiscipline referrals to speech language pathology (SLP), physical therapy (PT), and occupational therapy (OT). Group comparisons (referred vs. not-referred) and regression procedures were implemented to determine demographic and clinical variables that were associated with an increased likelihood of rehabilitation referral. RESULTS 35.3% of participants were referred to rehabilitation services. Of these, 25.1% received a multidiscipline referral. There was a statistically significant effect of disease stage on both single discipline (χ2(2) = 45.1, p < 0.0001) and multidiscipline (χ2(2) = 74.2, p < 0.0001) referrals, with higher rates in later stages. Referred vs. not-referred participants differed significantly on a number of variables; however, only falls in the 6-months prior, advanced- and moderate-stage disease, older age, hospital admissions, and higher caregiver burden were associated with an increased likelihood of rehabilitation referral (adjusted odds ratios ≥ 1, Range = 1.08 to 1.62). CONCLUSIONS Despite evidence supporting multidiscipline and proactive rehabilitation in PD, the majority of referrals were made to a single service and may be reactions to falls or advancing disease. Data suggest there may be missed opportunities for optimizing care through proactive rehabilitation interventions.
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Affiliation(s)
- Angela C Roberts
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, 2240 Campus Drive, Evanston, IL, 60025, USA.
| | - Miriam R Rafferty
- Shirley Ryan AbilityLab, Northwestern University Department of Physical Medicine and Rehabilitation and Department of Psychiatry and Behavioral Science, 355 E Erie St. 19th Floor, Chicago, IL, 60611, USA.
| | - Samuel S Wu
- Department of Biostatistics, College of Public Health & Health Professions College of Medicine, University of Florida, 2004 Mowry Rd P.O. Box 117450, Gainesville, FL, 32611, USA
| | - Guanhuong Miao
- Department of Biostatistics, College of Public Health & Health Professions College of Medicine, University of Florida, 2004 Mowry Rd P.O. Box 117450, Gainesville, FL, 32611, USA
| | - Fernando Cubillos
- Parkinson's Foundation, 200 SE 1st Street Ste 800, Miami, FL, 33131, USA
| | - Tanya Simuni
- Feinberg School of Medicine, Department of Neurology, Northwestern University Parkinson's Disease and Movement Disorders Center, Room 1900, NMH/259 E Erie, Chicago, IL, 60611, USA
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Khan U, Stoff L, Yahuaca JD, Bhagavat B, Toledo S, Goldman JG, Simuni T, Rafferty M. Evaluation of an Interdisciplinary Screening Program for People With Parkinson Disease and Movement Disorders. Arch Rehabil Res Clin Transl 2020; 2:100067. [PMID: 33543093 PMCID: PMC7853386 DOI: 10.1016/j.arrct.2020.100067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To describe the characteristics of people with Parkinson disease and movement disorders (PDMDs) referred by neurologist to a physiatrist-led interdisciplinary rehabilitation screening program. DESIGN Retrospective data analysis of electronic health records (EMRs). SETTING Outpatient PDMD neurology clinic and an interdisciplinary rehabilitation hospital's PDMD screening program. PARTICIPANTS People with PDMDs referred by neurologists to the interdisciplinary rehabilitation screening program from 2009-2017 (n=934), with early referrals from 2009-2015 (n=449) and recently referred from 2015-2017 (n=485), and patients who had new interdisciplinary rehabilitation screening program evaluations from 2015-2017 (n=183). INTERVENTION Participation in the physiatrist-led PDMD screening clinic. MAIN OUTCOME MEASURES Demographics, disease-related features, timed Up and Go, conversational voice volume, recommended therapy services, and number of therapies completed 90 days following interdisciplinary rehabilitation screening program. RESULTS People referred from the neurologists to the interdisciplinary rehabilitation screening program from 2009-2017 were 72±12.9 years old, male (56%), white (65%), and with 1 or more comorbidities (62%). Compared with early referrals from 2009-2015, more recently referred participants from 2015-2017 were younger (P<.001) and earlier in disease duration (P=.036). The interdisciplinary rehabilitation screening program participants from 2015-2017 had mean timed Up and Go time of 15.4±10.1 seconds and a mean conversational voice volume of 68.98±4.7 dB. CONCLUSIONS The interdisciplinary rehabilitation screening program was sustained with increased number of referrals over time, occurring earlier in the disease in more recent years. Key strategies used to sustain the program over time include development of a unique referral order set for the neurologists, implementation of a comprehensive screen tool in the rehabilitation hospital EMR, and centralized communication through social workers at both facilities.
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Affiliation(s)
- Uzma Khan
- Shirley Ryan AbilityLab, Chicago, Illinois
| | | | - J. Diego Yahuaca
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Bavna Bhagavat
- Shirley Ryan AbilityLab, Chicago, Illinois
- Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Santiago Toledo
- Shirley Ryan AbilityLab, Chicago, Illinois
- Northwestern University Department of Physical Medicine and Rehabilitation, Chicago, Illinois
| | - Jennifer G. Goldman
- Shirley Ryan AbilityLab, Chicago, Illinois
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Northwestern University Department of Physical Medicine and Rehabilitation, Chicago, Illinois
- Northwestern University Department of Neurology, Chicago, Illinois
| | - Tanya Simuni
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Northwestern University Department of Neurology, Chicago, Illinois
| | - Miriam Rafferty
- Shirley Ryan AbilityLab, Chicago, Illinois
- Northwestern University Department of Physical Medicine and Rehabilitation, Chicago, Illinois
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35
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Quinn L, Macpherson C, Long K, Shah H. Promoting Physical Activity via Telehealth in People With Parkinson Disease: The Path Forward After the COVID-19 Pandemic? Phys Ther 2020; 100:1730-1736. [PMID: 32734298 PMCID: PMC7454884 DOI: 10.1093/ptj/pzaa128] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/08/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE There is mounting evidence in support of exercise and physical activity as a first-line approach to managing symptoms and potentially altering disease progression in people with Parkinson disease (PD). For many patients, a critical gap is the need for expert guidance to overcome barriers, set realistic goals, and provide personalized advice to optimize exercise uptake and adherence. The purpose of this case report is to describe a physical activity coaching program (Engage-PD) for individuals newly diagnosed with PD and to highlight rapid modifications made to this program in response to the COVID-19 pandemic. METHODS (CASE DESCRIPTION) Engage-PD is a single cohort implementation study of a coaching intervention grounded in self-determination theory being conducted at Columbia University Parkinson's Foundation Center of Excellence in New York City, NY (USA), the early epicenter of the COVID-19 pandemic in the United States. The project was uniquely positioned to be adapted to telehealth delivery and to address an immediate need for support and guidance in the home environment, including people with early-mid-stage PD. Participants completed baseline and follow-up (3 months) assessments and participated in up to 4 coaching sessions, all delivered via a telehealth platform. The intervention incorporated 1:1 coaching, goal-setting, physical activity monitoring, and use of a disease-specific workbook to promote and support safe exercise uptake. RESULTS While the program is ongoing, 52 referrals were received and 27 individuals with PD enrolled in the first 2 months of the pandemic for a recruitment rate of 52%. Although direct comparisons with pre-coronavirus recruitment are difficult due to the recency of the Engage-PD implementation study, this recruitment rate was larger than expected, which may have been due to several factors (eg, most patients had limited, if any, access to in-person programs and therapy services during this time, so the Engage program filled an immediate need to provide exercise and activity guidance). There was a wide range of scores for both baseline physical activity and self-efficacy measures. CONCLUSION Remotely delivered interventions may serve as a sustainable platform for physical activity coaching programs for people with PD as well as other neurodegenerative diseases. IMPACT With the uncertainty brought about by the current pandemic, this case report highlights the opportunity to shift the current model of care for individuals with neurodegenerative diseases such as PD.
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Affiliation(s)
- Lori Quinn
- Department of Biobehavioral Sciences, Teachers College, Columbia University, and Department of Rehabilitation and Regenerative Medicine (Physical Therapy), Columbia University Irving Medical Center, 525 W 120th St, Box 199, New York City, NY 10027 USA,Address all correspondence to Dr Quinn at:
| | - Chelsea Macpherson
- Department of Biobehavioral Sciences, Teachers College, Columbia University
| | - Katrina Long
- Department of Biobehavioral Sciences, Teachers College, Columbia University
| | - Hiral Shah
- Department of Neurology, Columbia University Irving Medical Center
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Integrated and patient-centred management of Parkinson's disease: a network model for reshaping chronic neurological care. Lancet Neurol 2020; 19:623-634. [DOI: 10.1016/s1474-4422(20)30064-8] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 01/31/2020] [Accepted: 02/17/2020] [Indexed: 12/12/2022]
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Rafferty MR, MacDonald J, Byskosh A, Sloan L, Toledo S, Marciniak C, Simuni T. Using Implementation Frameworks to Provide Proactive Physical Therapy for People With Parkinson Disease: Case Report. Phys Ther 2019; 99:1644-1655. [PMID: 31508801 PMCID: PMC7372734 DOI: 10.1093/ptj/pzz129] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 03/15/2019] [Accepted: 04/12/2019] [Indexed: 11/14/2022]
Abstract
BACKGROUND AND PURPOSE European clinical practice guidelines recommend physical therapy for people with Parkinson disease (PD) soon after diagnosis to provide education, physical activity advice, and individualized interventions when needed. However, therapy is frequently not used until after gait and balance problems occur. The purpose of this administrative case study is to present the application of a proactive physical therapy (PAPT) approach at 1 rehabilitation center using implementation frameworks to support the (1) implementation process, (2) determinants of implementation success, and (3) implementation evaluation. CASE DESCRIPTION The PAPT program targeted people with PD before the onset of significant mobility dysfunction. It was initiated in 1 outpatient neurological rehabilitation center. The program used shared decision-making to promote long-term maintenance of independent exercise. The Knowledge-to-Action Framework was used by champions to plan implementation processes. Implementation barriers were addressed using the Consolidated Framework for Implementation Research. The program was evaluated using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework with mixed methods. OUTCOMES In the program's first year, 38 people were referred, 28 were evaluated, and 20 participated in the 6-month program evaluation. Following PAPT, the number of participants reporting regular participation in aerobic, strengthening, and flexibility exercise approximately doubled, while those engaging in balance activities increased from 1 to 8. They reported a median of 140 minutes of aerobic exercise per week. Implementation barriers included location, insurance coverage, and difficulty scheduling long-term follow-up visits. Participants reported physical and emotional benefits of the program. DISCUSSION Implementation frameworks assisted with the implementation and evaluation of a PAPT delivery model that helped people with PD to increase and maintain independent exercise participation.
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Affiliation(s)
- Miriam R Rafferty
- Shirley Ryan AbilityLab Illinois; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, 355 E Erie St, 19th Floor Strength and Endurance Lab, Chicago, IL 60611 (USA); and Department of Psychiatry and Behavioral Science, Feinberg School of Medicine, Northwestern University
| | - Jillian MacDonald
- Shirley Ryan AbilityLab. Dr MacDonald is a board-certified clinical specialist in neurologic physical therapy
| | | | | | - Santiago Toledo
- Shirley Ryan AbilityLab; and Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University
| | - Christina Marciniak
- AbilityLab; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University; and Department of Neurology, Feinberg School of Medicine, Northwestern University
| | - Tanya Simuni
- Department of Neurology, Feinberg School of Medicine, Northwestern University
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Gilbert RM, Standaert DG. Bridging the Gaps: More Inclusive Research Needed to Fully Understand Parkinson's Disease. Mov Disord 2019; 35:231-234. [DOI: 10.1002/mds.27906] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 09/19/2019] [Accepted: 09/27/2019] [Indexed: 01/14/2023] Open
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Borchers EE, McIsaac TL, Bazan-Wigle JK, Elkins AJ, Bay RC, Farley BG. A physical therapy decision-making tool for stratifying persons with Parkinson's disease into community exercise classes. Neurodegener Dis Manag 2019; 9:331-346. [PMID: 31686582 DOI: 10.2217/nmt-2019-0019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Aim: Physical therapy and exercise are considered essential components in the management of Parkinson's disease (PD). Using our retrospective data and years of experience in assigning persons with PD to multilevel group classes we propose a two-part physical therapy decision-making tool consisting of participant and exercise program considerations. Methods: Retrospective medical record review and therapist consensus identified evaluation considerations determined to aide clinical decision making. The ability of these variables (i.e., demographics, clinical characteristics, clinical measures cut-offs) to predict the class assignment decision of PD-specialized physical therapists was evaluated using discriminant function analysis. Results: Therapist-assigned groups differed significantly on all clinical measures (p < 0.001) which provided the categorical data required for discriminant analysis. Using all variables, the discriminant function analysis predicted class assignment of the therapists with 79% agreement. Conclusion: This proposed tool provides a framework that may guide the process for increasing access to multilevel group classes.
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Affiliation(s)
- Emily E Borchers
- NeuroFit Networks, Inc. DBA Parkinson Wellness Recovery
- PWR!, 3849 E. Broadway Blvd. STE163, Tucson, AZ 85716, USA
| | - Tara L McIsaac
- Department of Physical Therapy, Arizona School of Health Sciences, A.T. Still University, 5850 E. Still Circle, Mesa, AZ 85206, USA
| | - Jennifer K Bazan-Wigle
- NeuroFit Networks, Inc. DBA Parkinson Wellness Recovery
- PWR!, 3849 E. Broadway Blvd. STE163, Tucson, AZ 85716, USA
| | - Aaron J Elkins
- NeuroFit Networks, Inc. DBA Parkinson Wellness Recovery
- PWR!, 3849 E. Broadway Blvd. STE163, Tucson, AZ 85716, USA
| | - Ralph C Bay
- Department of Interdisciplinary Sciences, Arizona School of Health Sciences, A.T. Still University, 5850 E. Still Circle, Mesa, AZ 85206, USA
| | - Becky G Farley
- NeuroFit Networks, Inc. DBA Parkinson Wellness Recovery
- PWR!, 3849 E. Broadway Blvd. STE163, Tucson, AZ 85716, USA
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Disparities in Health Care for Hispanic Patients in Physical Medicine and Rehabilitation in the United States. Am J Phys Med Rehabil 2019; 99:338-347. [DOI: 10.1097/phm.0000000000001342] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bloem BR, Ypinga JHL, Willis A, Canning CG, Barker RA, Munneke M, De Vries NM. Using Medical Claims Analyses to Understand Interventions for Parkinson Patients. JOURNAL OF PARKINSONS DISEASE 2019; 8:45-58. [PMID: 29254108 PMCID: PMC5836412 DOI: 10.3233/jpd-171277] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The scientific evidence to support the value of a range of non-pharmacological interventions for people with Parkinson’s disease (PD) is increasing. However, showing unequivocally that specific interventions are better than usual care is not straightforward because of generic drawbacks of clinical trials. Here, we address these challenges, specifically related to the context of evaluating complex non-pharmacological interventions for people with PD. Moreover, we discuss the potential merits of undertaking “real world” analyses using medical claims data. We illustrate this approach by discussing an interesting recent publication in The Lancet Neurology, which used such an approach to demonstrate the value of specialized physiotherapy for PD patients, over and above usual care physiotherapy.
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Affiliation(s)
- Bastiaan R Bloem
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
| | - Jan H L Ypinga
- Department Care Purchasing, CZ Groep, Goes, The Netherlands
| | - Allison Willis
- Departments of Neurology and of Biostatistics, Epidemiology and Informatics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Colleen G Canning
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Roger A Barker
- Department of Clinical Neurosciences, John van Geest Centre for Brain Repair, University of Cambridge, UK
| | - Marten Munneke
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
| | - Nienke M De Vries
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
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Houghton R, Boess F, Verselis L, Ding Y, Freitas R, Constantinovici N, Ong R. Treatment Patterns in Patients with Incident Parkinson's Disease in the United States. JOURNAL OF PARKINSONS DISEASE 2019; 9:749-759. [PMID: 31424419 PMCID: PMC6839607 DOI: 10.3233/jpd-191636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Treatment patterns in Parkinson's disease (PD) have not been extensively studied for nearly two decades. Insurance claims are appropriate for such analysis. OBJECTIVE To understand the standard of care use of symptomatic treatments in new cases of PD and factors associated with treatment choice. METHODS Retrospective cohort study using claims data from the United States between 2008 and 2016. We used Kaplan-Meier methodology to estimate time to treatment start and switch or add-on therapy and Cox proportional hazards models to identify predictors. RESULTS We identified 68,532 patients eligible for treatment pattern analyses. Median time from diagnosis until first treatment was 37 days (95% confidence interval: 36-38). Two distinct patterns of treatment initiation were identified: fast initiators and patients with delayed treatment start (or no recorded treatment). Levodopa therapies were the most commonly prescribed treatment class (52.6%). Increased age was associated with shorter time to start of treatment with levodopa. Younger age was associated with shorter time to initiation of dopamine agonists and other symptomatic treatments. Patients that initiated treatment with levodopa/combinations had the fewest switches/add-ons [30.4%; median time 7.29 (6.71, 8.13) years]. Older patients had fewer switch/add-on therapies, but only in the group that started with levodopa/combination therapy. CONCLUSIONS Time from diagnosis to treatment start was relatively short, suggesting that PD diagnosis, as reflected in the database, is closely linked to start of symptomatic treatment. Levodopa treatment remains the most common treatment, especially for older patients. Delayed treatment start was associated with increased age and comorbidity.
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Affiliation(s)
- Richard Houghton
- Product Development Personalized Health Care, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Frank Boess
- Roche Pharma Research and Early Development, Neuroscience, Ophthalmology and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Lynne Verselis
- Roche Pharma Research and Early Development, Neuroscience, Ophthalmology and Rare Diseases Discovery and Translational Area, Roche Innovation Center New York, F. Hoffmann-La Roche Ltd., New York NY, USA
| | | | - Rita Freitas
- Product Development Personalized Health Care, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | | | - Rose Ong
- Product Development Personalized Health Care, F. Hoffmann-La Roche Ltd., Basel, Switzerland
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Pradhan S, Kelly VE. Quantifying physical activity in early Parkinson disease using a commercial activity monitor. Parkinsonism Relat Disord 2019; 66:171-175. [PMID: 31420310 DOI: 10.1016/j.parkreldis.2019.08.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 07/08/2019] [Accepted: 08/02/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Physical inactivity in Parkinson disease (PD) has an impact on motor and non-motor symptoms of the disease. It is unclear whether this decline in physical activity occurs early in the disease, in addition to any decline due to aging, and whether commercial activity monitors can be used to self-monitor physical activity levels in this population. OBJECTIVE To compare the quantity and intensity of physical activity (PA), as measured by commercial activity monitors, in people with mild PD and healthy older adults (HOA). A secondary objective was to assess adherence and user experience with wearing the activity monitoring device. METHODS An observational descriptive study design examined PA levels over a 14-day period using commercially-available activity monitors (Fitbit Charge HR). RESULTS Individuals with PD (n = 30) and HOA (n = 30) both demonstrated high adherence with wear time (PD = 13.8 [0.5] days, HOA = 13.9 [0.4] days, p = 0.55). People with PD took fewer steps per day than HOA (PD = 6416.9 (2795.5), HOA = 11441.3 (3932.1), p < 0.001). Compared to HOA, individuals with PD spent fewer minutes per day engaged in moderate to vigorous intensity activity (PD = 33.0 (22.5), HOA = 72.0(37.3), p < 0.001) and more minutes per day sedentary (PD = 803.74 (154.9), HOA = 578.26 (103.7), p < 0.001). Both groups reported that ease of use and satisfaction with the activity monitor were high. CONCLUSIONS People with mild PD demonstrated reduced quantity and intensity of PA compared to HOA. Both the PD and the HOA groups had good adherence wearing a commercial activity monitor that provided feedback regarding activity levels.
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Affiliation(s)
- Sujata Pradhan
- Division of Physical Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle, United states.
| | - Valerie E Kelly
- Division of Physical Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle, United states
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Rodrigues-de-Paula F, Lana RDC, Lopes LKR, Cardoso F, Lindquist ARR, Piemonte MEP, Correa CL, Israel VL, Mendes F, Lima LO. Determinants of the use of physiotherapy services among individuals with Parkinson's disease living in Brazil. ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 76:592-598. [PMID: 30365622 DOI: 10.1590/0004-282x20180087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 06/05/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To identify the factors affecting the use of physiotherapy services among individuals with Parkinson's disease (PD) living in Brazil. METHODS Overall, 479 individuals with idiopathic PD, of both sexes, at any stage of the Hoehn & Yahr (HY) scale, and from seven capital cities in Brazil were recruited from 2014 to 2016. Multivariate logistic regression was the main statistical tool. For the construction of the logistic model, the association of the dependent variable "physiotherapy" with the independent sociodemographic/economic and clinical variables: age, education, family income, time of PD since onset, HY, the activities of daily living and motor subscales of the Unified Parkinson's Disease Rating Scale, cognitive aspects, depressive symptoms, fear of falling, freezing gait, history of falls, physical activity level, gait speed, walking performance and balance, were verified. RESULTS The 479 individuals had an average age of 65.2 ± 11.0 years, 88% were in the HY I-III stages and 43.4% were under physiotherapy treatment. The analysis identified two determinant variables related to the use of the physiotherapy service: level of education (OR = 1.24) and walking performance (OR = 0.82). Decreased walking performance and a higher educational level increased the use of a physiotherapy service in individuals with PD living in Brazil. CONCLUSIONS The present study shows that individuals with PD, residents from different regions of Brazil, have limited access to physiotherapy services. In addition, the Brazilian Public Health Care System, as well as local programs, need to target PD individuals with a low educational level to improve their access to physiotherapy services. Goals should aim towards the development of physical exercise programs to improve the patients' functional performance for a longer period.
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Affiliation(s)
| | - Raquel de Carvalho Lana
- Universidade Federal de Minas Gerais, Departamento de Fisioterapia, Belo Horizonte MG, Brasil
| | | | - Francisco Cardoso
- Universidade Federal de Minas Gerais, Departamento de Clínica Médica, Belo Horizonte MG, Brasil
| | | | | | - Clynton Lourenço Correa
- Universidade Federal do Rio de Janeiro, Departamento de Fisioterapia, Rio de Janeiro RJ, Brasil
| | - Vera Lúcia Israel
- Universidade Federal do Paraná, Universidade de Fisioterapia, Curitiba PR, Brasil
| | - Felipe Mendes
- Universidade de Brasília, Departamento de Fisioterapia, Brasília DF, Brasil
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Mantri S, Fullard ME, Beck J, Willis AW. State-level prevalence, health service use, and spending vary widely among Medicare beneficiaries with Parkinson disease. NPJ Parkinsons Dis 2019; 5:1. [PMID: 30701188 PMCID: PMC6345811 DOI: 10.1038/s41531-019-0074-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 12/13/2018] [Indexed: 01/24/2023] Open
Abstract
State-level variations in disease, healthcare utilization, and spending influence healthcare planning at federal and state levels and should be examined to understand national disparities in health outcomes. This descriptive study examined state-level variations in Parkinson disease (PD) prevalence, patient characteristics, Medicare spending, out-of-pocket costs, and health service utilization using data on 27.5 million Medicare beneficiaries in the US in 2014. We found that 45.8% (n = 179,496) of Medicare beneficiaries diagnosed with PD were women; 26.1% (n = 102,205) were aged 85+. The District of Columbia, New York, Illinois, Connecticut, and Florida had the highest age-, race-, and sex-adjusted prevalence of Parkinson disease among Medicare beneficiaries in the US. Women comprised over 48.5% of PD patient populations in West Virginia, Kentucky, Mississippi, Louisiana, and Arkansas. More than 31% of the PD populations in Connecticut, Pennsylvania, Hawaii, and Rhode Island were aged 85+. PD patients who were "dual-eligible"-receiving both Medicare and Medicaid benefits-also varied by state, from <10% to >25%. Hospitalizations varied from 304 to 653 stays per 1000 PD patients and accounted for 26.5% of the 7.9 billion United States Dollars (USD) paid by the Medicare program for healthcare services delivered to our sample. A diagnosis of PD was associated with greater healthcare use and spending. This study provides initial evidence of substantial geographic variation in PD patient characteristics, health service use, and spending. Further study is necessary to inform the development of state- and federal-level health policies that are cost-efficient and support desired outcomes for PD patients.
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Affiliation(s)
- Sneha Mantri
- Parkinsons Disease Research, Education, and Clinical Center (PADRECC), Philadelphia VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104 USA
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Michelle E. Fullard
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - James Beck
- The Parkinson’s Foundation, New York, NY USA
| | - Allison W. Willis
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
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Gilbert RM. American Parkinson Disease Association Explores the Current Research in Diverse Parkinson’s Disease Populations. ACTA ACUST UNITED AC 2019. [DOI: 10.17925/usn.2019.15.2.63] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Rehabilitation Therapy Utilization in Patients with Parkinson's Disease in Korea. PARKINSONS DISEASE 2018; 2018:9475415. [PMID: 30538812 PMCID: PMC6261078 DOI: 10.1155/2018/9475415] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 10/28/2018] [Indexed: 11/17/2022]
Abstract
Objective Although evidence and guidelines recommend appropriate rehabilitation from the beginning of diagnosis in patients with Parkinson's disease (PD), there is a lack of data addressing the utilization of rehabilitation therapies for these patients in practice. The aim of this study is to investigate the rate of rehabilitation therapy utilization over time in patients with PD using a nationwide cohort in Korea. Methods Patients were identified using the registration code for PD in the program for rare, intractable disease from the National Health Insurance Service-National Sample Cohort database, which consists of 979,390 Korean residents. Data were divided into four periods: 2004-2006, 2007-2009, 2010-2012, and 2013-2015. We assessed the utilization of rehabilitation therapies and the associated patient characteristics. Results The numbers of patients with PD were 384 in 2004, 855 in 2007, 1,023 in 2010, and 1,222 in 2013. The numbers of physiatrist visits per person were 0.58, 0.96, 1.97, and 2.91, in the respective periods. Among the patients, 35-40% had claims for physical therapy, 16-19% for occupational therapy, and 4-6% for swallowing therapy. There were no remarkable differences between these rates between the study periods. Sex, age, income, disability, and levodopa-equivalent dose were significantly associated with the utilization of rehabilitation therapy. Conclusion This study demonstrated that the rate of rehabilitation therapy utilization did not change remarkably in patients with PD from 2004 to 2015 in Korea although the number of physiatrist visits increased dramatically. The present evidence and guidelines may have not been adequately integrated into clinical practice during the period of study. Additional efforts may be warranted to provide adequate rehabilitation therapies in clinical practice for patients with PD.
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Fullard ME, Willis AW. Author response: Utilization of rehabilitation therapy services in Parkinson disease in the United States. Neurology 2018; 90:813. [PMID: 29686121 PMCID: PMC10681071 DOI: 10.1212/wnl.0000000000005367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Bryant MS, Protas EJ. Reader response: Utilization of rehabilitation therapy services in Parkinson disease in the United States. Neurology 2018; 90:812. [DOI: 10.1212/wnl.0000000000005368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Ellis T, Rochester L. Mobilizing Parkinson's Disease: The Future of Exercise. JOURNAL OF PARKINSON'S DISEASE 2018; 8:S95-S100. [PMID: 30584167 PMCID: PMC6311359 DOI: 10.3233/jpd-181489] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/08/2018] [Indexed: 01/01/2023]
Abstract
Exercise is increasingly recognized as an important element in the treatment of Parkinson's disease but what is exercise targeting? What accounts for the benefits observed in Parkinson's disease? Is exercise disease modifying? Several modes of exercise have been studied in various doses across a heterogeneous Parkinson's population. Yet more clarity is needed as to who benefits most and when, from what type of exercise and at which intensity. In this paper, we briefly review the state of the art in key areas and speculate on the likely state of research in each area in the next 20 years. Key areas relate to: (1) the physiological benefits of exercise with respect to disease modification; (2) the best type of exercise; (3) the optimal intensity of exercise; and (4) implementation strategies to increase exercise uptake. A better understanding of these concepts would allow for a more effective, personalized approach, rather than the current "one size fits all" and could most likely confer greater benefits.
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Affiliation(s)
- Terry Ellis
- Boston University College of Health and Rehabilitation Sciences, Sargent College, Center for Neurorehabilitation, Boston, MA, USA
| | - Lynn Rochester
- Institute of Neuroscience, Newcastle University, Newcastle, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
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