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Multidisciplinary rehabilitation for people with Parkinson’s disease: a randomised controlled study
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  1. D T Wade1,
  2. H Gage2,
  3. C Owen3,
  4. P Trend4,
  5. C Grossmith5,
  6. J Kaye6
  1. 1Oxford Centre for Enablement, Windmill Road, Oxford, UK
  2. 2Department of Economics, University of Surrey, Guildford, UK
  3. 3Thomas Coram Research Unit, Institute of Education, London WC1, UK
  4. 4Department of Neurology, Royal County Surrey Hospital, Guildford
  5. 5Social Services Dept, Royal County Surrey Hospital
  6. 6Specialist Nurse, Surrey Hampshire Borders NHS Trust, Guildford
  1. Correspondence to:
    Professor Derick T Wade, Oxford Centre for Enablement, Windmill Road, Oxford OX3 7LD, UK;
    derick.wade{at}dial.pipex.com

Abstract

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.

  • Parkinson’s disease
  • rehabilitation
  • 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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