Mary Danoudis

Feasibility, safety, and compliance in a randomized controlled trial of physical therapy for Parkinson's disease.

Both efficacy and clinical feasibility deserve consideration in translation of research outcomes. This study evaluated the feasibility of rehabilitation programs within the context of a large randomized controlled trial of physical therapy. Ambulant participants with Parkinsons disease (PD) (n = 210) were randomized into three groups: (1) progressive strength training (PST); (2) movement strategy training (MST); or (3) control (“life skills”). PST and MST included fall prevention education. Feasibility was evaluated in terms of safety, retention, adherence, and compliance measures. Time to first fall during the intervention phase did not differ across groups, and adverse effects were minimal. Retention was high; only eight participants withdrew during or after the intervention phase. Strong adherence (attendance >80%) did not differ between groups (P = .435). Compliance in the therapy groups was high. All three programs proved feasible, suggesting they may be safely implemented for people with PD in community-based clinical practice.

Falls and mobility in Parkinson's disease: protocol for a randomised controlled clinical trial

BackgroundAlthough physical therapy and falls prevention education are argued to reduce falls and disability in people with idiopathic Parkinsons disease, this has not yet been confirmed with a large scale randomised controlled clinical trial. The study will investigate the effects on falls, mobility and quality of life of (i) movement strategy training combined with falls prevention education, (ii) progressive resistance strength training combined with falls prevention education, (iii) a generic life-skills social program (control group).Methods/DesignPeople with idiopathic Parkinsons disease who live at home will be recruited and randomly allocated to one of three groups. Each person shall receive therapy in an out-patient setting in groups of 3-4. Each group shall be scheduled to meet once per week for 2 hours for 8 consecutive weeks. All participants will also have a structured 2 hour home practice program for each week during the 8 week intervention phase. Assessments will occur before therapy, after the 8 week therapy program, and at 3 and 12 months after the intervention. A falls calendar will be kept by each participant for 12 months after outpatient therapy.Consistent with the recommendations of the Prevention of Falls Network Europe group, three falls variables will be used as the primary outcome measures: the number of fallers, the number of multiple fallers and the falls rate. In addition to quantifying falls, we shall measure mobility, activity limitations and quality of life as secondary outcomes.DiscussionThis study has the potential to determine whether outpatient movement strategy training combined with falls prevention education or progressive resistance strength training combined with falls prevention education are effective for reducing falls and improving mobility and life quality in people with Parkinsons disease who live at home.Trial registrationAustralia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12606000344594

Health-related quality of life and strain in caregivers of Australians with Parkinson’s disease: An observational study

BackgroundThe relationship between health-related quality of life (HRQoL) in people with Parkinson’s disease and their caregivers is little understood and any effects on caregiver strain remain unclear. This paper examines these relationships in an Australian sample.MethodsUsing the generic EuroQol (EQ-5D) and disease-specific Parkinson’s Disease Questionnaire-39 Item (PDQ-39), HRQoL was evaluated in a sample of 97 people with PD and their caregivers. Caregiver strain was assessed using the Modified Caregiver Strain Index. Associations were evaluated between: (i) caregiver and care-recipient HRQoL; (ii) caregiver HRQoL and caregiver strain, and; (iii) between caregiver strain and care-recipient HRQoL.ResultsNo statistically significant relationships were found between caregiver and care-recipient HRQoL, or between caregiver HRQoL and caregiver strain. Although this Australian sample of caregivers experienced relatively good HRQoL and moderately low strain, a significant correlation was found between HRQoL of people with PD and caregiver strain (rho 0.43, p < .001).ConclusionPoor HRQoL in people with PD is associated with higher strain in caregivers. Therapy interventions may target problems reported as most troublesome by people with PD, with potential to reduce strain on the caregiver.

Protocol for a home-based integrated physical therapy program to reduce falls and improve mobility in people with Parkinson’s disease

BackgroundThe high incidence of falls associated with Parkinson’s disease (PD) increases the risk of injuries and immobility and compromises quality of life. Although falls education and strengthening programs have shown some benefit in healthy older people, the ability of physical therapy interventions in home settings to reduce falls and improve mobility in people with Parkinson’s has not been convincingly demonstrated.Methods/design180 community living people with PD will be randomly allocated to receive either a home-based integrated rehabilitation program (progressive resistance strength training, movement strategy training and falls education) or a home-based life skills program (control intervention). Both programs comprise one hour of treatment and one hour of structured homework per week over six weeks of home therapy. Blinded assessments occurring before therapy commences, the week after completion of therapy and 12 months following intervention will establish both the immediate and long-term benefits of home-based rehabilitation. The number of falls, number of repeat falls, falls rate and time to first fall will be the primary measures used to quantify outcome. The economic costs associated with injurious falls, and the costs of running the integrated rehabilitation program from a health system perspective will be established. The effects of intervention on motor and global disability and on quality of life will also be examined.DiscussionThis study will provide new evidence on the outcomes and cost effectiveness of home-based movement rehabilitation programs for people living with PD.Trial registrationThe trial is registered on the Australian and New Zealand Clinical Trials Registry (ACTRN12608000390381).

Freezing of gait, fear of falling, and quality of life in people with Parkinson’s disease

Degeneration of the nigrostriatal dopaminergic system has traditionally been considered the pathological hallmark of Parkinson’s disease (PD). Recent neuropathological work, however, revealed that PD specific brain pathology extends far beyond the nigrostriatal dopaminergic system and affects widespread brain areas, including the olfactory system, autonomic and gain setting brainstem nuclei, and the cerebral cortex. In parallel, there has been a revival of interest in the non-motor features of PD. PD is now considered as a multisystem disorder, manifesting itself by a combination of the classical motor deficits and a wide range of non-motor disturbances, including autonomic dysregulation, hyposmia, sleep disturbances, depression, cognitive dysfunction, and psychosis. Evidence is accumulating that certain non-motor features of PD can develop at least several years before the onset of the motor symptoms. This has most convincingly been demonstrated for impaired olfaction and REM sleep behaviour disorder (RBD). Retrospective studies suggest that other symptoms, such as depression, autonomic dysfunction, and excessive daytime sleepiness may also antedate the motor symptoms. These so-called pre-motor symptoms most likely reflect early pathological changes in the olfactory bulb and tract, the lower brainstem, and possibly the peripheral autonomic nervous system, prior to the involvement of the substantia nigra. As such, pre-motor symptoms are an interesting target for the development of clinical screening tests to detect PD in the pre-motor phase. One of the most promising clinical pre-motor markers of PD is an impairment of the sense of smell, because of its high prevalence (8090% in the motor phase) and the non-invasiveness and low cost of olfactory testing. Prospective studies in first-degree relatives of PD patients and in a population-based cohort have established hyposmia as a risk factor for the development of PD, although the positive predictive value is low and the lead time appears to be relatively short. Idiopathic RBD has a higher positive predictive value than hyposmia and a longer lead time, but lacks sensitivity as only up to one third of PD patients suffer from this disorder. Although at this point no single pre-motor symptom is able to predict PD with high sensitivity and specificity, it is clear that clinical pre-motor markers of PD will be crucial to the development of neuroprotective treatment strategies.

Characteristics of freezing of gait in community dwelling people with Parkinson’s disease

Degeneration of the nigrostriatal dopaminergic system has traditionally been considered the pathological hallmark of Parkinson’s disease (PD). Recent neuropathological work, however, revealed that PD specific brain pathology extends far beyond the nigrostriatal dopaminergic system and affects widespread brain areas, including the olfactory system, autonomic and gain setting brainstem nuclei, and the cerebral cortex. In parallel, there has been a revival of interest in the non-motor features of PD. PD is now considered as a multisystem disorder, manifesting itself by a combination of the classical motor deficits and a wide range of non-motor disturbances, including autonomic dysregulation, hyposmia, sleep disturbances, depression, cognitive dysfunction, and psychosis. Evidence is accumulating that certain non-motor features of PD can develop at least several years before the onset of the motor symptoms. This has most convincingly been demonstrated for impaired olfaction and REM sleep behaviour disorder (RBD). Retrospective studies suggest that other symptoms, such as depression, autonomic dysfunction, and excessive daytime sleepiness may also antedate the motor symptoms. These so-called pre-motor symptoms most likely reflect early pathological changes in the olfactory bulb and tract, the lower brainstem, and possibly the peripheral autonomic nervous system, prior to the involvement of the substantia nigra. As such, pre-motor symptoms are an interesting target for the development of clinical screening tests to detect PD in the pre-motor phase. One of the most promising clinical pre-motor markers of PD is an impairment of the sense of smell, because of its high prevalence (8090% in the motor phase) and the non-invasiveness and low cost of olfactory testing. Prospective studies in first-degree relatives of PD patients and in a population-based cohort have established hyposmia as a risk factor for the development of PD, although the positive predictive value is low and the lead time appears to be relatively short. Idiopathic RBD has a higher positive predictive value than hyposmia and a longer lead time, but lacks sensitivity as only up to one third of PD patients suffer from this disorder. Although at this point no single pre-motor symptom is able to predict PD with high sensitivity and specificity, it is clear that clinical pre-motor markers of PD will be crucial to the development of neuroprotective treatment strategies.

Young onset Parkinson’s : characteristic movement disorders and profile of an Australian sample

Degeneration of the nigrostriatal dopaminergic system has traditionally been considered the pathological hallmark of Parkinson’s disease (PD). Recent neuropathological work, however, revealed that PD specific brain pathology extends far beyond the nigrostriatal dopaminergic system and affects widespread brain areas, including the olfactory system, autonomic and gain setting brainstem nuclei, and the cerebral cortex. In parallel, there has been a revival of interest in the non-motor features of PD. PD is now considered as a multisystem disorder, manifesting itself by a combination of the classical motor deficits and a wide range of non-motor disturbances, including autonomic dysregulation, hyposmia, sleep disturbances, depression, cognitive dysfunction, and psychosis. Evidence is accumulating that certain non-motor features of PD can develop at least several years before the onset of the motor symptoms. This has most convincingly been demonstrated for impaired olfaction and REM sleep behaviour disorder (RBD). Retrospective studies suggest that other symptoms, such as depression, autonomic dysfunction, and excessive daytime sleepiness may also antedate the motor symptoms. These so-called pre-motor symptoms most likely reflect early pathological changes in the olfactory bulb and tract, the lower brainstem, and possibly the peripheral autonomic nervous system, prior to the involvement of the substantia nigra. As such, pre-motor symptoms are an interesting target for the development of clinical screening tests to detect PD in the pre-motor phase. One of the most promising clinical pre-motor markers of PD is an impairment of the sense of smell, because of its high prevalence (8090% in the motor phase) and the non-invasiveness and low cost of olfactory testing. Prospective studies in first-degree relatives of PD patients and in a population-based cohort have established hyposmia as a risk factor for the development of PD, although the positive predictive value is low and the lead time appears to be relatively short. Idiopathic RBD has a higher positive predictive value than hyposmia and a longer lead time, but lacks sensitivity as only up to one third of PD patients suffer from this disorder. Although at this point no single pre-motor symptom is able to predict PD with high sensitivity and specificity, it is clear that clinical pre-motor markers of PD will be crucial to the development of neuroprotective treatment strategies.