PAPER

Multidisciplinary rehabilitation for people with Parkinson’s disease: a randomised controlled study

D T Wade¹, H Gage², C Owen³, P Trend⁴, C Grossmith⁵ and J Kaye⁶

¹ Oxford Centre for Enablement, Windmill Road, Oxford, UK
² Department of Economics, University of Surrey, Guildford, UK
³ Thomas Coram Research Unit, Institute of Education, London WC1, UK
⁴ Department of Neurology, Royal County Surrey Hospital, Guildford
⁵ Social Services Dept, Royal County Surrey Hospital
⁶ Specialist Nurse, Surrey Hampshire Borders NHS Trust, Guildford

Correspondence to:
Correspondence to:
Professor Derick T Wade, Oxford Centre for Enablement, Windmill Road, Oxford OX3 7LD, UK;
derick.wade{at}dial.pipex.com

Objective: To determine whether a programme of multidisciplinary rehabilitation and group support achieves sustained benefit for people with Parkinson’s disease or their carers.

Methods: The study was a randomised controlled crossover trial comparing patients and carers who had received rehabilitation four months before assessment with those who had not. Patients were recruited from a neurology clinic, attended a day hospital from home weekly for six weeks using private car or hospital transport, and received group educational activities and individual rehabilitation from a multidisciplinary team. Patients were assessed at entry and at six months using a 25 item self assessment Parkinson’s disease disability questionnaire, Euroqol-5d, SF-36, PDQ-39, hospital anxiety and depression scale, and timed stand-walk-sit test. Carers were assessed using the carer strain index and Euroqol-5d.

Results: 144 people with Parkinson’s disease without severe cognitive losses and able to travel to hospital were registered (seven were duplicate registrations); 94 had assessments at baseline and six months. Repeated measures analysis of variance comparing patients at the 24 week crossover point showed that those receiving rehabilitation had a trend towards better stand-walk-sit score (p = 0.093) and worse general and mental health (p = 0.002, p = 0.019). Carers of treated patients had a trend towards more strain (p = 0.086). Analysis comparing patients before and six months after treatment showed worsening in disability, quality of life, and carer strain.

Conclusions: Patients with Parkinson’s disease decline significantly over six months, but a short spell of multidisciplinary rehabilitation may improve mobility. Follow up treatments may be needed to maintain any benefit.

Keywords: Parkinson’s disease; rehabilitation

Abbreviations: HAD, hospital anxiety and depression scale; NHPT, nine hole peg test; PDQ, Parkinson’s disease questionnaire; SF-36, short form 36 item health survey; UPDRS, unified Parkinson’s disease rating scale

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