Efficacy of occupational therapy for patients with Parkinson's disease

Article Reviews
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Read Full Text: Efficacy of occupational therapy for patients with Parkinson’s disease: A randomised controlled trial (Available for free through ProQuest with your NBCOT membership)
Journal: The Lancet Neurology
Year Published: 2014
Ranked 7th on our 2014-2019 list of the 50 most influential articles

Article overview for OT practitioners

Back in OT school (around 2010), I remember us talking a lot about treatment guidelines and protocols––but actually looking at very few.

That’s what makes an article like this so exciting––it gives complete treatment guidelines for home health OTs seeing patients with mild Parkinson’s Disease (PD).

And the best part is that the study revealed that this home-based, individualized OT treatment resulted in patients’ self-perceived improvement in daily activities.

What is the role of OT?

191 patients were randomly assigned to a control group and an intervention group. Over a 10-week period, on average, the intervention group received a sum of 9.4 hours of direct care time. (Note that no more than 16 total hours was given to any patient.) Sessions were approximately one hour long.

Interventions included:

  • Use of alternative and compensatory strategies to improve task performance.
  • Advice on optimization of daily routines and simplification of activities.
  • Advice on appropriate environmental aids to enhance independence, efficiency and safety.

See the 142-page Guidelines for Occupational Therapy in Parkinson’s Disease Rehabilitation to explore the protocol upon which this study was built.

Assessments utilized

The primary measure utilized at three and six months following the interventions was one that is familiar to many OTs: The Canadian Occupational Performance measure. (By the way, has anyone been using the web-app version of this? I think it looks sweet!)

Here are some secondary assessments that stood out to me as particularly helpful for OTs.

Limitations

The approach was part of a broader ParkinsonNet care model.

This study was conducted in the Netherlands, home of ParkinsonNet. This unique network comprises professionals from various disciplines and trains them on evidence-based, multidisciplinary approaches to addressing PD. Because of this unique setup found in the Netherlands, it might be hard to replicate the study’s findings in other countries.

Therapists in the study received extra Parkonson’s Disease-specific training.

Another factor to keep in mind is the amount of extra training received by the therapists in this study. This means the results may not transfer to other settings and scenarios, as many OTs have not received this level of training. The participating therapists received the following training/coaching:

  • Three days of training to be part of ParkinsonNet.
  • Three additional days of PD-specific training before the start of the study.
  • One day of additional training halfway through the study.
  • Unlimited access to an expert OT with advanced knowledge of PD.

Takeaways

There are treatment guidelines out there for you!

Categorically speaking, there are not enough treatment guidelines out there for rehab professionals.

But, that doesn’t mean there aren’t any! They do exist, and if you’re working with a new diagnosis––or you see a single diagnosis on a regular basis––it is worth searching to see if you can find guidelines to guide your practice.

The future is multidisciplinary

I’m feeling like every article we review has an emphasis on interdisciplinary care. Even though this study focused specifically on OT care, it was still within the milieu of the interdisciplinary ParkinsonNet network. The future is definitely interdisciplinary.

Many Parkinson’s patients miss out on OT care.

In the introduction to the article, the authors cite several surveys about the number of patients with PD who actually receive occupational therapy and summarize that the use of OT for this population is “limited.” Another issue they bring up is the timing of referral. One study showed that the mean time for the first referral to OT was 6 years after the initial diagnosis, “suggesting that any potential role of OT in prevention of functional decline in early PD is not used fully.”

This is a discussion I frequently see in the PT and OT realm: there are so many patients we could be helping, but we simply aren’t reaching them. I expect to see continued conversation on this.

Listen to a summary in podcast form


Find other platforms for listening to the OT Potential Podcast here.

What questions/thoughts does this article raise for you?

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@SarahLyon: I think we were in OT school at the same time! (I graduated in 2013).

I love that this article studied treatment application within a Home Health setting for these individuals. In my limited experience working with individuals with Parkinson’s, I’ve seen how difficult it can be for these individuals to get out-and-about for treatments, medical appointments, etc. so helping them to regain independence at home is such a confidence boost that oftentimes carries over into their other life roles.

Does anyone else feel the average amount of time between diagnosis of PD and referral to OT has more to do with the patient/family’s perception of deficits/functionality or is it related to more of a need for OT to educate MDs on the benefit of early OT intervention to prolong functionality and independence as long as possible?

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Hey @otmollyb! Yes! We have been OTs for about the same amount of time! I graduated from NYU in 2011!

I really like your question about average time to referral. Historically, I would have said that more education is needed for our MDs. But, I think it is equally important that we make client facing information about our services more accessible online. If someone ever reads this and has expertise in OT and Parkinson’s I would love to create a client facing blog post with you to help educate on our role with Parkinson’s clients :slight_smile:

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Dang. Wow. Another great topic! So many thoughts come up and yes, great question on referrals @otmollyb. I wonder what it’s really about, too. I bet it is a large part of OT advocacy to be honest. Perhaps that it’s a referral topic in general that is missing in our system because I often feel that in home health I am missing out on referrals when it comes time to discharge from home health (feeling like there is so much more out in the community that I could be referring to that I just don’t know about). I hope to soon create and trial a Home Health Referral list or at least a template for use in cities/communities. What if every setting had one? What if every community had one? Maybe it’s just called google now, lol. What this also brings to mind is the consideration of sheer relationship. It sounds like there is a lot more real-time (vs online) relationship in the community that is supporting and driving the care and referrals. How or do we return to this? Sounds like Health 3.0.

I thought it was also fascinating to see that the timing was realistic (approx 10 hours of therapy in 10 weeks in home health) and the extensive amount of training that the therapists had. That is inspiring.

That Parkinson’s Disease Questionnaire is fantastic, too. Thanks for sharing that. I have not used the app with the COPM and dream of incorporating it more someday.

Take homes for me: Referrals matter (and getting proper knowledge to be and make referrals). Training and protocols matter. OT in the home matters. Relationships among the health care system as a WHOLE matters. Great idea on reaching out to clients directly Sarah with a blog post.

Has anyone done education/OT promotion to MD offices in order to help with more timely referrals? If so, what would you pass on to others interested in doing so?

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@monika, what are you thinking your home health referral list would include? Is it a resource for MDs? I really like the sounds of it!

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Lol. @SarahLyon, here’s the snapshot dream. I actually initially thought it would be for the families. So often in home health we are a LAUNCHING point, but what supports are we REALLY giving them? There are SO many resources in communities that could support families once all traditional health care has “discharged” but often (especially if you’re a travel OT) it’s hard to know what and where these places are. So what if the chamber of commerce or churches collaborated to create a list or handout of most commonly needed services? This could include handypeople (aka handiman services) for grab bar installations, outpatient facilities (including those that have specializations), private hire caregiving options, driving/transporation supports, grocery delivery options, church services for those in need (including rides to/from), lists of accessible churches, support groups. To be honest, Aurora may be a fascinating case study for possibilities. It could be equally or more important though to start with a referral sheet for MD (offices). What if it was a form that sat in the waiting room? (You NOW people have time to read in that room.) And on that form is could talk about OT (inpatient, home health, outpatient). What are ya’ll thoughts? Anyone already seeing or using anything like this? Now I’m all OT-giddy. Lol.

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@Kim does something like this exist in Aurora? It would be a great project for a student. It would also be a great resources to have on an OT website, it could position your department as an authoritative resource and it could bring traffic that might benefit from our services.

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