Ingrid Hwm Sturkenboom

Efficacy of occupational therapy for patients with Parkinson's disease: a randomised controlled trial

BACKGROUND There is insufficient evidence to support use of occupational therapy interventions for patients with Parkinsons disease. We aimed to assess the efficacy of occupational therapy in improving daily activities of patients with Parkinsons disease. METHODS We did a multicentre, assessor-masked, randomised controlled clinical trial in ten hospitals in nine Dutch regional networks of specialised health-care professionals (ParkinsonNet), with assessment at 3 months and 6 months. Patients with Parkinsons disease with self-reported difficulties in daily activities were included, along with their primary caregivers. Patients were randomly assigned (2:1) to the intervention or control group by a computer-generated minimisation algorithm. The intervention consisted of 10 weeks of home-based occupational therapy according to national practice guidelines; control individuals received usual care with no occupational therapy. The primary outcome was self-perceived performance in daily activities at 3 months, assessed with the Canadian Occupational Performance Measure (score 1-10). Data were analysed using linear mixed models for repeated measures (intention-to-treat principle). Assessors monitored safety by asking patients about any unusual health events during the preceding 3 months. This trial is registered with ClinicalTrials.gov, NCT01336127. FINDINGS Between April 14, 2011, and Nov 2, 2012, 191 patients were randomly assigned to the intervention group (n=124) or the control group (n=67). 117 (94%) of 124 patients in the intervention group and 63 (94%) of 67 in the control group had a participating caregiver. At baseline, the median score on the Canadian Occupational Performance Measure was 4·3 (IQR 3·5-5·0) in the intervention group and 4·4 (3·8-5·0) in the control group. At 3 months, these scores were 5·8 (5·0-6·4) and 4·6 (4·6-6·6), respectively. The adjusted mean difference in score between groups at 3 months was in favour of the intervention group (1·2; 95% CI 0·8-1·6; p<0·0001). There were no adverse events associated with the study. INTERPRETATION Home-based, individualised occupational therapy led to an improvement in self-perceived performance in daily activities in patients with Parkinsons disease. Further work should identify which factors related to the patient, environmental context, or therapist might predict which patients are most likely to benefit from occupational therapy. FUNDING Prinses Beatrix Spierfonds and Parkinson Vereniging.

Allied health care interventions and complementary therapies in Parkinson's disease

Allied health care and complementary therapies are used by many patients with Parkinsons disease (PD). For allied health care, supportive scientific evidence is gradually beginning to emerge, and interventions are increasingly integrated in the treatment programs for PD patients. To evaluate whether such multidisciplinary programs are justifiable, we review the literature of allied health care and complementary therapies in PD. According to the level of available evidence, we provide recommendations for clinical practice. Finally, we discuss the need for an improved organization of allied health care, and identify topics for future research to further underpin the pros and cons of allied health care and complementary therapies in PD.

The impact of occupational therapy in Parkinson’s disease: a randomized controlled feasibility study

Aim: To evaluate the feasibility of a randomized controlled trial including process and potential impact of occupational therapy in Parkinson’s disease. Design: Process and outcome were quantitatively and qualitatively evaluated in an exploratory multicentre, two-armed randomized controlled trial at three months. Participants: Forty-three community-dwelling patients with Parkinson’s disease and difficulties in daily activities, their primary caregivers and seven occupational therapists. Intervention: Ten weeks of home-based occupational therapy according to the Dutch guidelines of occupational therapy in Parkinson’s disease versus no occupational therapy in the control group. Main measures: Process evaluation measured accrual, drop-out, intervention delivery and protocol adherence. Primary outcome measures of patients assessed daily functioning: Canadian Occupational Performance Measure (COPM) and Assessment of Motor and Process Skills. Primary outcome for caregivers was caregiver burden: Zarit Burden Inventory. Participants’ perspectives of the intervention were explored using questionnaires and in-depth interviews. Results: Inclusion was 23% (43/189), drop-out 7% (3/43) and unblinding of assessors 33% (13/40). Full intervention protocol adherence was 74% (20/27), but only 60% (71/119) of baseline Canadian Occupational Performance Measure priorities were addressed in the intervention. The outcome measures revealed negligible to small effects in favour of the intervention group. Almost all patients and caregivers of the intervention group were satisfied with the results. They perceived: ‘more grip on the situation’ and used ‘practical advices that make life easier’. Therapists were satisfied, but wished for a longer intervention period. Conclusions: The positive perceived impact of occupational therapy warrants a large-scale trial. Adaptations in instructions and training are needed to use the Canadian Occupational Performance Measure as primary outcome measure.

Economic evaluation of occupational therapy in Parkinson's disease: A randomized controlled trial

A large randomized clinical trial (the Occupational Therapy in Parkinsons Disease [OTiP] study) recently demonstrated that home‐based occupational therapy improves perceived performance in daily activities of people with Parkinsons disease (PD). The aim of the current study was to evaluate the cost‐effectiveness of this intervention.

Effectiveness of occupational therapy in Parkinson’s disease: study protocol for a randomized controlled trial

BackgroundOccupational therapists may have an added value in the care of patients with Parkinson’s disease whose daily functioning is compromised, as well as for their immediate caregivers. Evidence for this added value is inconclusive due to a lack of rigorous studies. The aim of this trial is to evaluate the (cost) effectiveness of occupational therapy in improving daily functioning of patients with Parkinson’s disease.Methods/DesignA multicenter, assessor-blinded, two-armed randomized controlled clinical trial will be conducted, with evaluations at three and six months. One hundred ninety-two home-dwelling patients with Parkinson’s disease and with an occupational therapy indication will be assigned to the experimental group or to the control group (2:1). Patients and their caregivers in the experimental group will receive ten weeks of home-based occupational therapy according to recent Dutch guidelines. The intervention will be delivered by occupational therapists who have been specifically trained to treat patients according to these guidelines. Participants in the control group will not receive occupational therapy during the study period. The primary outcome for the patient is self-perceived daily functioning at three months, assessed with the Canadian Occupational Performance Measure. Secondary patient-related outcomes include: objective performance of daily activities, self-perceived satisfaction with performance in daily activities, participation, impact of fatigue, proactive coping skills, health-related quality of life, overall quality of life, health-related costs, and effectiveness at six months. All outcomes at the caregiver level will be secondary and will include self-perceived burden of care, objective burden of care, proactive coping skills, overall quality of life, and care-related costs. Effectiveness will be evaluated using a covariance analysis of the difference in outcome at three months. An economic evaluation from a societal perspective will be conducted, as well as a process evaluation.DiscussionThis is the first large-scale trial specifically evaluating occupational therapy in Parkinson’s disease. It is expected to generate important new information about the possible added value of occupational therapy on daily functioning of patients with Parkinson’s disease.Trial registrationClinicaltrials.gov: NCT01336127.

The construct validity of the Dutch version of the activity card sort

Abstract Purpose: Establishing construct validity of the ACS-NL in individuals with Parkinson’s disease (PD). Method: Discriminative validity was established in 191 community-dwelling individuals with PD using an extreme groups design (Hoehn and Yahr stages 1 and 3). Convergent validity was determined by relating the performance scores of the ACS-NL to the scores of the Canadian Occupational Performance Measure (COPM) and the Parkinson’s Disease Questionnaire (PDQ-39) scores, and relating ACS-NL satisfaction scores to the COPM scores and to the Utrecht Scale for Evaluation of Rehabilitation Participation (USER-P). Results: The ACS-NL discriminated between individuals with PD with H&Y stages 1 and 3 (U = 524.5, Z = −5.453). ACS-NL performance scores correlated weakly with COPM scores (r = (0).19) and moderately with PDQ-39 scores (r = 0.44–0.55). The ACS-NL satisfaction scores correlated weakly with COPM scores (r = 0.23), and moderately with USER-P scores (r ≥ 0.40). Conclusions: This study contributed to the validation of the ACS-NL. The assessment enhances the possibility of monitoring participation in activities in individuals with PD. Implications for Rehabilitation The ACS-NL appears to hold good potential for use in the assessment of participation in activities in individuals with PD. The ACS-NL has added value parallel to administration of other instruments measuring participation (COPM) and quality of life (PDQ-39). This study demonstrates the capacity of the ACS to measure a unique construct of participation and helps to improve the psychometric properties and administration of the ACS-NL in practice.

A process evaluation of a home-based occupational therapy intervention for Parkinson’s patients and their caregivers performed alongside a randomized controlled trial

Objective: To evaluate fidelity, treatment enactment and the experiences of an occupational therapy intervention in Parkinson’s disease, to identify factors that affect intervention delivery and benefits. Design: Mixed methods alongside a randomized controlled trial. Subjects: These include 124 home-dwelling Parkinson’s disease patients and their primary caregivers (recipients), and 18 occupational therapists. Intervention: Ten-week home-based intervention according to the Dutch guidelines for occupational therapy in Parkinson’s disease. Main measures: Data were collected on intervention dose, protocol process, content of treatment (fidelity), offered and performed strategies (treatment enactment), and recipients’ experiences. Therapists’ experiences were collected through case note analyses and focus group interviews. Results: Mean intervention dose was 9.3 (SD 2.3) hours. Mean protocol process adherence was high (93%; SD 9%), however the intervention did not (fully) address the goal for 268 of 617 treatment goals. Frequencies of offered and performed strategies appeared similar, apart from ‘using other tools and materials’ which showed a drop from 279 advised to 149 used. The recipients were satisfied overall with the intervention (mean score 8 out of 10). The therapists noted positive or negative influencing factors on both process and benefits: the research context, the socio-political healthcare context, the recipients’ personal and contextual factors, and the therapists’ competence. Conclusion: We found some prerequisite factors in equipment provision and available dose important for treatment delivery. Other elicited factors related to, or affected, the required professional competencies and tools to tailor interventions to the complexity of interacting personal and contextual factors of patients and caregivers.

Physical and occupational therapy

The graduate entry-level program in Physical Therapy is a professional entry level program designed to prepare students for licensure to practice as physical therapists. The program is accredited by the Commission on Accreditation in Physical Therapy Education of the American Physical Therapy Association. The Doctor of Physical Therapy program (DPT) was granted re-accreditation status by the Commission on Accreditation in Physical Therapy Education (CAPTE) in May 2016. Prospective students having questions about the programs accreditation status should contact:

The Perceive, Recall, Plan and Perform (PRPP) system for persons with Parkinson’s disease: a psychometric study

Abstract Background: The Perceive, Recall, Plan & Perform (PRPP) system of task analysis might be feasible to evaluate occupational performance and information processing strategies for persons with Parkinson’s disease (PD). Aim: To evaluate: (1) the random error between raters (inter-rater study), (2) the random error within raters (intra-rater study), and (3) the internal consistency of the PRPP. Materials and methods: (1) video-recorded performance of meaningful activities of 13 Dutch persons with PD, scored independently by 38 Dutch PRPP trained occupational therapists were included in the analysis. The random error between raters was analyzed with two-way random Intraclass Correlation Coefficients (ICC). (2) Four videos were scored twice by 30 raters (6 week time interval). The random error within raters was analyzed using one-way random ICC’s. (3) Internal consistency study: data of 190 persons with PD were analyzed using Cronbach’s alpha (α). Results: Inter-rater reliability ranged from slight to moderate (ICC= 0.06–0.43). The mean intra-rater reliability ranged from moderate to almost perfect (ICC= 0.60–0.83). Internal consistency is good (α = 0.60–0.86). Conclusion: The limited inter-rater reliability but adequate intra-rater reliability and internal consistency show the feasibility of the PRPP when used for persons with PD. Implications for reliable clinical use are discussed.