Rehabilitation in Parkinson's disease

Short-term effectiveness of intensive multidisciplinary rehabilitation for people with Parkinson's disease and their carers

OBJECTIVE

To evaluate the short-term effectiveness of an intensive multidisciplinary rehabilitation programme for people with Parkinson's disease and their carers.

DESIGN

Observational, with assessments before and after intervention.

SETTING

An elderly care day unit in a district general hospital in south-east England.

SUBJECTS

One hundred and eighteen people with Parkinson's disease and no cognitive impairment, and their carers.

INTERVENTION

Participants attended the day hospital in groups of six patients with their carers for one day per week over six consecutive weeks. After assessment, they received individual treatment from a specialist team. Weekly group activities included relaxation and talks from experts.

OUTCOME MEASURES

Patients and carers were assessed for: health-related quality of life, psychological well-being, social services need, perceptions of the programme. Patients were additionally assessed for mobility, gait and speech. Carers were assessed for strain.

RESULTS

After treatment significant improvements were recorded in patients' mobility and gait (p < 0.05), speech (p < 0.001), depression (p = 0.029), health-related quality of life (p = 0.001). People with more advanced disease at baseline gained significantly more from treatment (p < or = 0.04). Carers were less depressed and had higher health-related quality of life than patients at baseline (p < 0.001) and no improvements in these indicators were recorded after treatment. A high unmet need for social services was identified in 31% of participants, and 10% of carers were found in danger of being unable to continue caring. Participants reported knowledge gains and high levels of satisfaction with both individual therapies and group activities.

CONCLUSIONS

This intensive co-ordinated programme provided immediate benefits to people with Parkinson's disease and their carers.

Fall events described by people with Parkinson's disease: implications for clinical interviewing and the research agenda

BACKGROUND AND PURPOSE

The aim of this study was to describe the terminology used by people with Parkinson's disease (PD) when recounting falls and near-misses (fall events) and to identify the surrounding circumstances.

METHOD

This cross-sectional study (part of an investigation identifying risk factors for falling in PD) utilized structured interviews about falling, conducted in participants' homes. Content analysis of participants' descriptions of events was performed. Fifty-five independently mobile, community-dwelling people with PD, identified via general practices in Southampton took part in the study.

RESULTS

Mean participant age was 71.5 years (SD = 7.6 years); mean time since diagnosis was 3.6 years (SD = 2.3 years). Thirty-four participants (62%) reported having fallen and 41 (75%) reported having nearly fallen in the previous 12 months. Recounting events, participants mentioned the location, frequency, process and landing, their activity and fall-avoidance. Falls at home, tripping, events arising when turning, falling forward, frequent near-misses and unsuccessful restoration of balance were commonly described.

CONCLUSIONS

Frequent recounting of processes, locations and landings suggest these details are memorable and easily recalled. Eliciting the activities during which events occurred, their frequency and avoidance-strategies, may necessitate probing by interviewers. An interview schedule is proposed. Aspects common to falls and near-misses, particularly turning, suggest a natural progression of activity-related falls.

Does selegiline delay progression of Parkinson's disease? A critical re-evaluation of the DATATOP study

The deprenyl and tocopherol antioxidative treatment (DATATOP) study has shown that selegiline (deprenyl), with or without tocopherol, reduces physical and psychological deficits in patients with Parkinson's disease within one month of treatment and reduces the probability of reaching a primary endpoint, the decision to treat with levodopa. This paper critically re-evaluates the inference that selegiline has a neuroprotective effect and thus delays progression of Parkinson's disease. Analysis is based on a simple model which assumes that clinically measured impairment is proportional to degree of cellular dysfunction in Parkinson's disease. The analysis suggests that the reduced probability of reaching an endpoint was due to a direct treatment effect rather than to neuroprotection.