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
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