13 March 2008
Carl E
Clarke, Alexander Furmston, Eric Morgan, Smitaa Patel, Cath Sackley, M F
Walker, Stirling Bryan and Keith Wheatley
Objective: To perform a pilot trial of
occupational therapy (OT) to optimise functional independence in
Parkinson's disease (PD) to
assess accrual/withdrawal rates,
acceptability, outcome measures, and inform sample size calculation.
Method: Non-demented
patients with idiopathic PD and difficulties with activities of daily
living (ADL) were recruited provided they
had not received OT in the last 2 years
and/or physiotherapy in the last year. Patients were randomised to
immediate OT or
OT after completion of the trial.
Patients randomised to OT were assessed at home by an experienced
therapist then received
6 home treatment sessions over 2
months. Interventions were targeted at functional independence and
mobility goals. Outcome
measures were: Nottingham Extended
Activity of Daily Living Scale, Rivermead Mobility Index, Unified
Parkinson's Disease Rating
Scale ADL scale, Parkinson's Disease
Questionnaire 39, EuroQol-EQ-5D, Hospital Anxiety and Depression Scale,
and health economics
analysis.
Results: 39 patients
(25 male; mean age 73 years) were recruited from four centres over 16
months. The mean difference in NEADL at
8 months was 3.5 (95%CI -3.2; 10.2).
The mean difference in PDQ-39 Summary Score was 3.8 (95% CI -4.94;
12.6). There were
strong correlations between the PDQ-39
and other outcomes. The intervention was acceptable to patients, with a
low withdrawal
rate and good questionnaire completion.
Conclusion:
Randomisation to a trial of OT in PD is feasible. NEADL and PDQ-39 are
relevant outcomes and provided data to inform sample
size for an adequately powered
randomised trial for which there is pressing need.
