Objective: Prediction of the effect of a home physiotherapy intervention on the basis of four clinical characteristics of patients with advanced Parkinson's disease.
Design: A repeated measures design comparing six weeks without treatment with six weeks of physiotherapy and a follow-up of 12 weeks.
Subjects: Persons with Parkinson's disease without dementia and suffering from considerable functional disability.
Intervention: Community physiotherapists treated patients in the home situation three times a week teaching cueing and conscious movement control for walking and carrying out transfers in and out of beds and chairs.
Main outcome measures: Mental status, disease severity, age and mood were included as predictor variables. A new functional scale developed as part of a previous study was used as the dependent variable administered in both the hospital and the home to determine whether the outcome generalized from the learning to a different environment.
Results: Only disease severity was a negative predictor of treatment outcome at home. In the hospital setting none of the factors predicted the immediate effect of treatment but cognitive ability and age were determinants of whether the treatment effects were maintained in the long term.
Conclusions: Using cueing and cognitive strategies benefited younger and older patients with Parkinson's disease alike. However, the findings indicate targeting of treatment at patients with milder disease severity and providing follow-up treatment for older and cognitively less able patients.
Get full access to this article
View all access options for this article.
References
1.
Comella CL, Stebbins GT, Brown-Toms N, Goetz C. Physical therapy and Parkinson's disease:a controlled clinical trial. Neurology1994; 44:376–378.
2.
Dam M, Tonin P, Casson S et al. Effects of conventional and sensory-enhanced physiotherapy on disability of Parkinson's disease patients. Adv Neurol1996; 69:551–555.
3.
Formisano R, Pratesi L, Modarelli FT, Bonifati V, Meco G. Rehabilitation and Parkinson's disease. Scand J Rehabil Med1992; 24:157–160.
4.
Canning CG, Alison JA, Allen NE, Groeller H. Parkinsons-Disease – an investigation of exercise capacity, respiratory-function and gait. Arch Phys Med Rehabil1997; 78:199–207.
5.
Bridgewater KJ, Sharpe MH. Aerobic exercise and early Parkinson's disease. J Neuro Rehabil1996; 10:233–241.
6.
Bridgewater KJ, Sharpe MH. Trunk muscle training and early Parkinson's disease. Physiother Theory Pract1997; 13:139–153.
7.
Schenkman M, Cutson TM, Kuchibhatla M et al. Exercise to improve spinal flexibility and function for people with Parkinson's disease:a randomized, controlled trial. J Am Geriatr Soc1998; 46:1207–1216.
8.
Nieuwboer A, De Weerdt W, Dom R, Truyen M, Janssens L, Kamsma YPT. The effect of a home physiotherapy programme for persons with Parkinson's disease. J Rehabil Med2001; 33:266–272.
9.
Dick JPR, Guiloff RJ, Stewart A et al. Mini-mental state examination in neurological patients. J Neurol Neurosurg Psychiatry1984; 47:496–499.
10.
Kamsma YPT, Brouwer WH, Lakke JPWF. Training of compensational strategies for impaired gross motor skills in Parkinson's disease. Physiother Theory Pract1995; 11:209–229.
11.
Nieuwboer A, De Weerdt W, Dom R, Bogaerts K, Nuyens G. Development of an activity scale for individuals with advanced Parkinson's disease:reliability and “on-off” variability. Phys Ther2000; 80:1087–1096.
12.
Fahn S, Elton RL. Unified Parkinson's Disease Rating Scale. In:Fahn S, Marsden CD, Goldstein M, Calne DB eds. Recent developments in Parkinson's disease. New York:Macmillan, 1987:153–163.
13.
Emanuels-Zuurveen ES, Brouwer WH, Lakke JPWF, Bouhuys AL. Physical symptoms of Parkinson's disease and the score on the Beck's Depression Inventory. Tijdschr Gerontol Geriatr1991; 22:134–137.
14.
Molloy DW, Standish TIM. Mental status and neuropsychological assessment:a guide to the standardised mini-mental state examination. Int Psychogeriatr1997; 9:87–94.
15.
Martinez-Martin P, Gil-Nagel A, Gracia LM, Gomez JB, Martinez-Sarries J, Bermejo F. Unified Parkinson's Disease Rating Scale characteristics and structure. Mov Disord1994; 9:76–83.
16.
Richards M, Marder K, Cote L, Mayeux R. Interrater reliability of the Unified Parkinson's Disease Rating Scale Motor Examination. Mov Disord1994; 9:89–91.
17.
Verbeke G, Molenberghs G. Linear mixed models in practice. A SAS-oriented approach. Lecture notes in statistics 126. New-York:Springer-Verlag, 1997.
18.
Littell RC, Milliken GA, Stroup WW, Wolfinger RD. SAS system for mixed models, first edition. Cary:SAS Institute Inc, 1996.
Bridgewater KJ, Sharpe MH. Trunk muscle performance in early Parkinson's disease. Phys Ther1998; 78:566–576.
21.
Plant RD, Jones DC, Hutchinson A et al. Physiotherapy in Parkinson's disease – referral, contact and discharge patterns (abstr). Mov Disord2000; 15:171-171.
22.
Jones DC, Chandler C. Strategy mapping in Parkinson's disease (abstr). In:Proceedings 6th European Congress on Research in Rehabilitation, Federation of German Pension Insurance Institutes (VDR) Berlin, 1998:370–371.
23.
Farina E, Gattellaro G, Pomati S et al. Researching a differential impairment of frontal function and explicit memory in early Parkinson's disease. Eur J Neurol2000; 7:259–267.
