1
|
Papa EV, Tolman J, Meyerhoeffer C, Reierson K. Motivational Modulation Enhances Movement Performance in Parkinson's Disease: A Systematic Review. PHYSICAL THERAPY REVIEWS 2024; 29:117-127. [PMID: 39036073 PMCID: PMC11259181 DOI: 10.1080/10833196.2024.2365568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/04/2024] [Indexed: 07/23/2024]
Abstract
Background The assessment of motivation and its modulation during treatment are essential aspects of physical therapy practice. However, the modulation of motivation has been sparsely investigated in persons with Parkinson's disease (PD) and at present no studies have synthesized its effects on movement performance. Objectives 4The purpose of this study was to systematically examine the efficacy of motivational modulation on movement performance in PD and to provide recommendations for its role in physical therapy practice. Methods Systematic identification of published literature was performed adhering to PRISMA guidelines, from January 2005 to March 2023. Keywords were used in the following electronic databases: PubMed, Academic Search Complete, the Cochrane Database, Google Scholar, and the Physiotherapy Evidence Database (PEDro). A level of evidence rating was completed according to the scale provided by the American Academy of Cerebral Palsy and Development Medicine. Quality assessments were performed using the Modified Downs and Black checklist. Results Eight studies were included in this review, all achieving level III evidence. The methodological quality of studies was varied, with most studies attaining a fair rating. Persons with PD performed upper extremity movement tasks with greater intensity when incentivized with larger rewards compared to smaller incentives. Dopamine replacement medication, Deep Brain Stimulation, and a history of depression, had mediating effects on the response to motivational modulation. Conclusions Our findings suggest that it is plausible to improve adherence to exercise when physical therapists modulate motivation through computerized game achievements, gamification of tasks, or other forms of reward and non-rewarding stimuli.
Collapse
Affiliation(s)
- Evan V. Papa
- Department of Rehabilitation Sciences, Tufts University School of Medicine, Boston, USA
| | - Jason Tolman
- Acute Care Physical Therapy Residency University of Utah, Salt Lake City, USA
| | | | | |
Collapse
|
2
|
O'Neal SK, Miller SA, Eikenberry MC, Moore ES. A backward cycling programme for people with Parkinson's disease: a feasibility and preliminary results study. J Rehabil Med 2024; 56:jrm17738. [PMID: 38860715 PMCID: PMC11182036 DOI: 10.2340/jrm.v56.17738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 05/13/2024] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVE To assess the feasibility of backward cycling for people with Parkinson's disease. Secondary objectives were to assess changes in gait and balance following a 6-week program. DESIGN A single-group prospective pre-test, post-test study with 1-month follow-up. SUBJECTS/PATIENTS Twenty-six people with Parkinson's disease (mean age: 69 (7.74) years, gender: 83% males, time since diagnosis: 6 (4.44) years). METHODS Participants pedaled backward on a stationary bicycle for 30 minutes at moderate intensity twice a week for 6 weeks. Feasibility was assessed by acceptability, suitability, and burden. Data collected at pre- and post-intervention with 1-month follow-up included backward stepping response variables, forward/backward gait variables, Mini-Balance Evaluation Systems Test (MBT), and 6 Minute Walk Test. RESULTS There was a high retention rate (95.8%) and adherence rate (100%) with one adverse event and minimal burden. Significant improvements were seen in step count and excursion distance during backward stepping responses, forward and backward gait velocity, forward step length, and the Mini-BESTest. CONCLUSION Backward cycling was a feasible intervention for people with Parkinson's disease, demonstrating low burden with high retention and adherence rates, and it is a safe exercise with the potential for benefits in gait and balance variables.
Collapse
Affiliation(s)
| | - Stephanie A Miller
- University of Indianapolis, Indianapolis, Indiana, USA
- Marian University, Indianapolis, IN, USA
| | | | | |
Collapse
|
3
|
Buscemi V, Boaz A, Dawes H, Jaki T, Jones F, Marsden J, Paul L, Playle R, Randell E, Robling M, Rochester L, Busse M, Ramdharry G. Exploring the issues that influence how people with rare neurological conditions engage in physical activity. Disabil Rehabil 2024; 46:2789-2798. [PMID: 37401644 DOI: 10.1080/09638288.2023.2230128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 06/23/2023] [Indexed: 07/05/2023]
Abstract
PURPOSE People with rare neurological conditions (RNCs) struggle to achieve regular physical activity (PA). This study explored experiences of people with RNC engaging in PA, their carers, and health care professionals (HCPs) working with them. MATERIALS & METHODS We developed three surveys: for individuals living with RNCs, their carers, and HCPs working with them. Themes from interviews with RNC charity representatives were used to co-design questions, together with people living with RNCs, their representatives, and an expert panel. Surveys were disseminated via charity mailing lists, social media accounts, and professional networks (HCPs). RESULTS We received 436 responses (225 people with RNC, 94 carers, 117 HCPs). Most respondents with RNC achieved some level of regular PA but needed motivation to maintain it. Many felt they lacked knowledge on starting and staying active, with scarce resources and support. Most HCP respondents worked in specialist services, and overwhelmingly agreed that people with RNC should be physically active, while acknowledging lack of evidence and resources. CONCLUSIONS We identified key barriers at environmental/organisational, interpersonal, and intrapersonal levels, highlighting a critical lack of support for people with RNC across UK health services. These factors can be targeted to increase engagement in PA.Implications for rehabilitationPeople living with rare neurological conditions experience barriers to engaging in physical activity, with some common to more prevalent neurological diseases, e.g. access and facilities, but some notable differences due to the rarity of the conditionFor people living with rare neurological conditions, and their carers, there is a lack of knowledge on safe and appropriate engagement in physical activityIncreasing the knowledge of health and exercise professionals may improve how they support people with rare neurological disease to engage with physical activity.Evidence based resources and recommendations for people living with rare neurological conditions, and professionals working with them, may facilitate engagement in physical activity.
Collapse
Affiliation(s)
- Valentina Buscemi
- Queen Square Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, UCLH NHS Trust, London, UK
- Department of Neuromuscular Diseases, UCL Institute of Neurology, London, UK
| | - Annette Boaz
- Faculty of Health, Social Care and Education, St. George's University of London, London, UK
- Faculty of Health, Social Care and Education, Kingston University, London, UK
| | - Helen Dawes
- Centre for Movement, Occupational and Rehabilitation Sciences, Oxford Brookes University, Oxford, UK
| | - Thomas Jaki
- Department of Mathematics and Statistics, University of Lancaster, Lancaster, UK
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Fiona Jones
- Faculty of Health, Social Care and Education, St. George's University of London, London, UK
- Faculty of Health, Social Care and Education, Kingston University, London, UK
| | | | - Lorna Paul
- Department of Physiotherapy and Paramedicine, Glasgow Caledonian University, Glasgow, UK
| | - Rebecca Playle
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | | | - Lynn Rochester
- Institute of Neuroscience, Newcastle University, Newcastle, UK
| | - Monica Busse
- Institute of Neuroscience, Newcastle University, Newcastle, UK
| | - Gita Ramdharry
- Queen Square Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, UCLH NHS Trust, London, UK
- Department of Neuromuscular Diseases, UCL Institute of Neurology, London, UK
| |
Collapse
|
4
|
Brandín-de la Cruz N, Jiménez-Sánchez C, Herrero P, Córdova-Alegre P, Buesa-Estéllez A, Calvo S. Experiences of patients with Parkinson's disease belonging to an association. A qualitative approach. ENFERMERIA CLINICA (ENGLISH EDITION) 2024; 34:161-167. [PMID: 38796106 DOI: 10.1016/j.enfcle.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 03/13/2024] [Indexed: 05/28/2024]
Abstract
INTRODUCTION Parkinson's disease (PD) affects the physical, cognitive, emotional, and social domains of people who suffer it. A good strategy for patients is to belong to an Association, using the services they offer. OBJECTIVE The aim of this study was to explore the experiences and perceptions of patients with PD in a Parkinson's Association. METHODS A sample of participants with PD who met the inclusion criteria was selected through purpose and theoretical sampling. Semi-structured qualitative interviews were used to collect the data, which was analyzed by thematic phenomenological analysis. Different strategies such as triangulation between researchers were used to ensure methodological rigor. RESULTS The data analyzed from 10 participants led to two themes: the context of the Association, where the importance of interdisciplinary treatments and the relationship with other patients is collected; and how they see their future, which describes the future perspectives that patients with PD have. DISCUSSION Patients agree on the importance of belonging to the Association, feeling part of a group, while benefiting from receiving therapies from the interdisciplinary team. The Association plays a relevant role in the evolution of the disease, as it influences how patients imagine their future. Developing strategies based on a good therapeutic alliance with professionals at the service of patients promotes the empowerment, adherence and continuity of treatments at home, which results in improving the quality of life of patients with PD.
Collapse
Affiliation(s)
- Natalia Brandín-de la Cruz
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad San Jorge, Campus Universitario Villanueva de Gállego, Villanueva de Gállego, Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón, IIS Aragón, Zaragoza, Spain
| | - Carolina Jiménez-Sánchez
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad San Jorge, Campus Universitario Villanueva de Gállego, Villanueva de Gállego, Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón, IIS Aragón, Zaragoza, Spain
| | - Pablo Herrero
- Instituto de Investigación Sanitaria de Aragón, IIS Aragón, Zaragoza, Spain; Departamento de Fisiatría y Enfermería, Facultad de Ciencias de la Salud, Universidad de Zaragoza, Zaragoza, Spain
| | - Paula Córdova-Alegre
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad San Jorge, Campus Universitario Villanueva de Gállego, Villanueva de Gállego, Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón, IIS Aragón, Zaragoza, Spain
| | - Almudena Buesa-Estéllez
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad San Jorge, Campus Universitario Villanueva de Gállego, Villanueva de Gállego, Zaragoza, Spain.
| | - Sandra Calvo
- Instituto de Investigación Sanitaria de Aragón, IIS Aragón, Zaragoza, Spain; Departamento de Fisiatría y Enfermería, Facultad de Ciencias de la Salud, Universidad de Zaragoza, Zaragoza, Spain
| |
Collapse
|
5
|
Agley L, Hartley P, Duffill D, Iqbal A, Mackett A, Rennie KL, Lafortune L. Digital Intervention Promoting Physical Activity in People Newly Diagnosed with Parkinson's Disease: Feasibility and Acceptability of the Knowledge, Exercise-Efficacy and Participation (KEEP) Intervention. JOURNAL OF PARKINSON'S DISEASE 2024; 14:1193-1210. [PMID: 39093079 DOI: 10.3233/jpd-240071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
Background Exercise promotion interventions for people with Parkinson's disease (PD) are often offered on a face-to-face basis, follow a generic "one-size-fit-all" approach, and are not typically delivered at diagnosis. Considering PD's heterogenous nature, the existing evidence on the merits of exercise on symptom management and the expressed wishes of people living with PD for access to timely and tailored evidence-based information, there is a demand for interventions that are easily accessible, scalable and co-designed with people living with PD. Objective Evaluate the feasibility and acceptability of a co-designed digital intervention promoting exercise and physical activity, in people newly diagnosed with PD. Methods Thirty people living with PD for less than one year participated in an assessor-blinded randomized feasibility trial from June 2022 to April 2023. The intervention group received the 8-week Knowledge, Exercise Efficacy and Participation (KEEP) intervention comprising 6 interactive digital modules and 4 online live group discussions facilitated by a specialist physiotherapist. Assessments were performed at baseline, post intervention and at 6-month follow up. Results Thirty participants were recruited to target with a 64% recruitment rate (30/47). All but one participant completed the 6-month follow-up assessment. There was high retention (97%), module completion (91%), and online discussion attendance (88%). Outcome measure collection was feasible, including accelerometer data with a daily average wear time of 23.9 hours (SD:0.295). Conclusions The KEEP intervention was feasible and acceptable in people newly diagnosed with PD. A larger trial is needed to assess intervention efficacy and correlation between knowledge, self-efficacy, and activity levels.
Collapse
Affiliation(s)
- Ledia Agley
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Peter Hartley
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Department of Physiotherapy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Danielle Duffill
- Department of Neurological Conditions, Cambridgeshire and Peterborough Foundation Trust, Cambridge, UK
| | - Arshi Iqbal
- Department of Physiotherapy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Alistair Mackett
- Department of Medicine for the Elderly, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Louise Lafortune
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| |
Collapse
|
6
|
Fowler King B, MacDonald J, Stoff L, Nettnin E, Jayaraman A, Goldman JG, Rafferty M. Activity Monitoring in Parkinson Disease: A Qualitative Study of Implementation Determinants. J Neurol Phys Ther 2023; 47:189-199. [PMID: 37306418 DOI: 10.1097/npt.0000000000000451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND PURPOSE There is interest in incorporating digital health technology in routine practice. We integrate multiple stakeholder perspectives to describe implementation determinants (barriers and facilitators) regarding digital health technology use to facilitate exercise behavior change for people with Parkinson disease in outpatient physical therapy. METHODS The purposeful sample included people with Parkinson disease (n = 13), outpatient physical therapists (n = 12), and advanced technology stakeholders including researchers and reimbursement specialists (n = 13). Semistructured interviews were used to elicit implementation determinants related to using digital health technology for activity monitoring and exercise behavior change. Deductive codes based on the Consolidated Framework for Implementation Research were used to describe implementation determinants. RESULTS Key implementation determinants were similar across stakeholder groups. Essential characteristics of digital health technology included design quality and packaging, adaptability, complexity, and cost. Implementation of digital health technology by physical therapists and people with Parkinson disease was influenced by their knowledge, attitudes, and varied confidence levels in using digital health technology. Inner setting organizational determinants included available resources and access to knowledge/information. Process determinants included device interoperability with medical record systems and workflow integration. Outer setting barriers included lack of external policies, regulations, and collaboration with device companies. DISCUSSION AND CONCLUSIONS Future implementation interventions should address key determinants, including required processes for how and when physical therapists instruct people with Parkinson disease on digital health technology, organizational readiness, workflow integration, and characteristics of physical therapists and people with Parkinson disease who may have ingrained beliefs regarding their ability and willingness to use digital health technology. Although site-specific barriers should be addressed, digital health technology knowledge translation tools tailored to individuals with varied confidence levels may be generalizable across clinics.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content available at: http://links.lww.com/JNPT/A436 ).
Collapse
Affiliation(s)
- Bridget Fowler King
- Shirley Ryan AbilityLab, Chicago, Illinois (B.F.K., J.M., L.S., E.N., A.J., J.G.G., M.R.); and Departments of Physical Medicine and Rehabilitation (A.J., J.G.G., M.R.), Physical Therapy & Human Movement Sciences (A.J.), Medical Social Sciences (A.J.), Neurology (J.G.G), and Psychiatry and Behavioral Science (M.R.), Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | | | | | | |
Collapse
|
7
|
Rafferty MR, Hoffman L, Feeney M, Schulte C, Hutber A, Galati T, Neric F, Ellis TD. Parallel development of Parkinson's-specific competencies for exercise professionals and criteria for exercise education programs. Parkinsonism Relat Disord 2023:105407. [PMID: 37202275 DOI: 10.1016/j.parkreldis.2023.105407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/14/2023] [Accepted: 04/16/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION The Parkinson's Foundation sought to develop Parkinson's specific competencies for exercise professionals who work with people with Parkinson's (PwP). These competencies built upon exercise guidelines and professional competencies for healthy populations. The purpose of this article is to describe the development of the professional competencies, continuing education criteria, and a pilot accreditation process. METHODS Competency development included: (1) an expert panel conducting an environmental scan, within the USA, related to exercise professional education in Parkinson's and synthesizing Parkinson's-specific exercise guidelines, (2) surveying people with Parkinson's in the USA, and (3) developing the competencies and curriculum criteria with psychometricians. A pilot accreditation process for Parkinson's exercise educational programs and continuing education courses includes an application, baseline, 6- and 12-month assessments. Activities reported here did not require ethical review. The survey was approved by NORC at the University of Chicago's Institutional Review Board (IRB). RESULTS The environmental scan, exercise guidelines, and survey (n = 627) informed competency development. The five key condition-specific domains were: (1) foundational information on the disease and role of exercise, (2) exercise screening, (3) group and individual exercise design, (4) behavior and counseling for exercise, and (5) interprofessional communication and program development. Seven applicants were accredited as certification programs (n = 3) or continuing education courses (n = 4). DISCUSSION The competencies, curriculum criteria, and accreditation processes support exercise professionals working with PwP. Reducing variation in the knowledge and skills of exercise professionals can improve the safe implementation and effectiveness of exercise programs, which are a critical part of integrated plan for people with Parkinson's disease (PD).
Collapse
Affiliation(s)
- Miriam R Rafferty
- Shirley Ryan AbilityLab, Chicago, IL, USA; Department Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL, USA; Department Psychiatry and Behavioral Science, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Carol Schulte
- Parkinson's Foundation Research Advocate, Red Bank, NJ, USA
| | - Adrian Hutber
- Valley Consortium for Medical Education, Modesto, CA, USA
| | - Todd Galati
- American Council on Exercise, San Diego, CA, USA
| | - Francis Neric
- Certification and Credentialing, American College of Sports Medicine, Indianapolis, IN, USA
| | - Terry D Ellis
- Department of Physical Therapy, Boston University College of Health and Rehabilitation Sciences: Sargent College, Boston, MA, USA
| |
Collapse
|
8
|
Danoudis M, Iansek R. A long-term community gym program for people with Parkinson's disease: a feasibility study of the Monash Health "Health and Fitness" model. Disabil Rehabil 2022; 44:7330-7338. [PMID: 34546146 DOI: 10.1080/09638288.2021.1977396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To investigate the feasibility and acceptability of the Health and Fitness Program (HFP), a long-term community gym program for people with mild to moderate Parkinson's disease (PD). METHODS Physiotherapists, with PD expertise, developed individualised exercise programs for new HFP members in consultation with them. Gym instructors, with PD training, supervised the HFP sessions. Exercises included progressive strength training, aerobic, balance, and stretching. Participants who had been enrolled in the HFP for 12 months, were recruited to a single group pre/post design study to test the program's feasibility and acceptability. Feasibility included safety, retention, attendance, and compliance data and acceptability measured using a customised questionnaire. RESULTS 17 of the 20 HFP members enrolled maintained membership for 12 months and participated in this study. The program was shown to be feasible with no falls reported during sessions, only one participant reported pain from exercising lasting more than 48 h, retention was high (85%) and most members complied with their program. Overall satisfaction with the program was high, with seven somewhat satisfied and 10 very satisfied. CONCLUSION The HFP demonstrated that a PD community gym program is feasible and acceptable when physiotherapists and PD-trained instructors collaborate to provide individualized exercise programs.IMPLICATIONS FOR REHABILITATIONPeople with Parkinson's disease need support to maintain long-term adherence to regular exercise which can be achieved with supervised community-based gym programs.A community-based PD-specific exercise program can be safe and acceptable to people with PD when PD specialist physiotherapists are involved in planning participants' exercise programs and PD-trained gym instructors supervise the exercise sessions.Members are satisfied with programs that have strategies in place to minimise barriers to participation, such as keeping costs to members low, providing a quality service, having supportive trained staff, and creating opportunities for social interaction between members.Evidence-based community exercise programs may result in improved strength and aerobic fitness and maintain quality of life in people with mild to moderate PD however further research using an RCT study is needed.
Collapse
Affiliation(s)
- Mary Danoudis
- Clinical Research Centre for Movement Disorders and Gait, Parkinson's Foundation Center of Excellence, Monash Health, Kingston Centre, Melbourne, Australia.,Faculty of Medicine, Nursing and Health Sciences, School of Clinical Sciences, Monash University, Clayton, Australia
| | - Robert Iansek
- Clinical Research Centre for Movement Disorders and Gait, Parkinson's Foundation Center of Excellence, Monash Health, Kingston Centre, Melbourne, Australia.,Faculty of Medicine, Nursing and Health Sciences, School of Clinical Sciences, Monash University, Clayton, Australia
| |
Collapse
|
9
|
Physical Activity Coaching via Telehealth for People With Parkinson Disease: A Cohort Study. J Neurol Phys Ther 2022; 46:240-250. [PMID: 36170256 DOI: 10.1097/npt.0000000000000410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Physical activity (PA) has many known benefits for people with Parkinson disease (PD); however, many people do not meet recommended levels of frequency or intensity. We designed Engage-PD, a PA coaching program delivered via telehealth and grounded in self-determination theory to promote PA uptake and facilitate exercise self-efficacy in people with Parkinson disease. This study aimed to determine the feasibility and preliminary efficacy of Engage-PD, and to explore whether baseline characteristics were associated with outcomes. METHODS A single cohort of people with PD (n = 62, Hoehn and Yahr I-III) participated in the 3-month Engage-PD program, which consisted of up to 5 telehealth coaching sessions delivered by physical therapists. Feasibility was evaluated based on recruitment and retention rates, along with participants' feedback. Planned and unplanned PA, exercise self-efficacy (ESE), and individualized goals were assessed pre- and post-intervention. Relationships between baseline characteristics and changes in planned PA and ESE were also evaluated. RESULTS Recruitment (62%) and retention (85%) rates were high, and the intervention was well accepted and perceived by the participants. From pre- to postintervention, participants increased planned PA (d = 0.33), ESE (d = 1.20), and individualized goal performance (d = 1.63) and satisfaction (d = 1.70). Participants with lower baseline planned PA experienced greater improvements in planned PA, and those with lower baseline ESE experienced greater improvements in ESE. DISCUSSION AND CONCLUSIONS A telehealth PA coaching program for people with PD was feasible and potentially efficacious. Physical therapist-led coaching may be an important component of a consultative model of care starting early in the disease process.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A393).
Collapse
|
10
|
Atkins KJ, Friel CP, Andrews SC, Chong TTJ, Stout JC, Quinn L. A qualitative examination of apathy and physical activity in Huntington's and Parkinson's disease. Neurodegener Dis Manag 2022; 12:129-139. [PMID: 35412856 DOI: 10.2217/nmt-2021-0047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Aim: In Huntington's disease (HD) and Parkinson's disease (PD), apathy is a frequently cited barrier to participation in physical activity. Current diagnostic criteria emphasize dissociable variants of apathy that differentially affect goal-directed behavior. How these dimensions present and affect physical activity in HD and PD is unknown. Methods: Using a qualitative approach, we examined the experience of apathy and its impact on physical activity in 20 people with early-manifest HD or idiopathic PD. Results: Two major themes emerged: the multidimensionality of apathy, including initiation or goal-identification difficulties, and the interplay of apathy and fatigue; and facilitators of physical activity, including routines, safe environments and education. Conclusion: Physical activity interventions tailored to apathy phenotypes may maximize participant engagement.
Collapse
Affiliation(s)
- Kelly J Atkins
- School of Psychological Sciences, Turner Institute for Brain & Mental Health, Monash University, Melbourne, VIC, 3800, Australia
| | - Ciarán P Friel
- Center for Personalized Health, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, 11030, USA
| | - Sophie C Andrews
- School of Psychological Sciences, Turner Institute for Brain & Mental Health, Monash University, Melbourne, VIC, 3800, Australia.,Neuroscience Research Australia, Sydney, NSW, 2031, Australia.,School of Psychology, University of New South Wales, Sydney, NSW, 2033, Australia
| | - Trevor T-J Chong
- School of Psychological Sciences, Turner Institute for Brain & Mental Health, Monash University, Melbourne, VIC, 3800, Australia.,Department of Neurology, Alfred Health, Melbourne, VIC, 3004, Australia.,Department of Clinical Neurosciences, St Vincent's Hospital, Melbourne, VIC, 3065, Australia
| | - Julie C Stout
- School of Psychological Sciences, Turner Institute for Brain & Mental Health, Monash University, Melbourne, VIC, 3800, Australia
| | - Lori Quinn
- Department of Biobehavioral Sciences, Teacher's College, Columbia University, New York City, NY, 10027, USA.,Centre for Trials Research, Cardiff University, Cardiff, Wales, CF14 4YS, UK
| |
Collapse
|
11
|
Bek J, Arakaki AI, Derbyshire-Fox F, Ganapathy G, Sullivan M, Poliakoff E. More Than Movement: Exploring Motor Simulation, Creativity, and Function in Co-developed Dance for Parkinson’s. Front Psychol 2022; 13:731264. [PMID: 35295373 PMCID: PMC8918650 DOI: 10.3389/fpsyg.2022.731264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 01/19/2022] [Indexed: 12/03/2022] Open
Abstract
Dance is an enjoyable, non-therapy-focused activity that may provide a range of benefits for people with Parkinson’s. The internal simulation of movement through observation, imitation, and imagery, is intrinsic to dance and may contribute to functional improvements for people with Parkinson’s. This study explored the feasibility and potential benefits of a dance program designed by a collaborative team of dance artists, researchers, physiotherapists, and people living with Parkinson’s. The program incorporated motor simulation through observation, imitation and imagery of movement, supported by creative themes, expression, and music. A 6-week pilot trial of the program was conducted with 10 people with Parkinson’s. A focus group following the trial (N = 8) provided insights into the use of imagery, observation and imitation within dance, and the link between creativity and functional outcomes, as well as indicating multidimensional benefits of dance as reported in previous studies. Exploratory outcome measures also suggested potential effects on motor simulation, functional dexterity, and quality of life. The present study demonstrates the feasibility of a co-developed dance program for Parkinson’s and indicates how creative elements of dance may support functional outcomes. Future research should examine the role of motor simulation processes in dance for Parkinson’s, including the potential to develop transferable cognitive-motor skills. This study also highlights the value of collaborative partnerships in designing dance for health programs, which may optimise beneficial effects by using creative approaches to incorporate evidence-based elements, with guidance from individuals with lived experience to ensure the relevance to their goals.
Collapse
Affiliation(s)
- Judith Bek
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
- *Correspondence: Judith Bek,
| | - Aline I. Arakaki
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
| | | | | | - Matthew Sullivan
- School of Science and the Environment, Manchester Metropolitan University, Manchester, United Kingdom
| | - Ellen Poliakoff
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
| |
Collapse
|
12
|
Nettnin E, Burrows S, Miao G, Wu SS, Simon DK, Rafferty MR. Associations between exercise classes and self-reported exercise by people with Parkinson's disease at Parkinson's foundation centers of excellence. Clin Park Relat Disord 2022; 6:100137. [PMID: 35252834 PMCID: PMC8892167 DOI: 10.1016/j.prdoa.2022.100137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 01/20/2022] [Accepted: 02/07/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Despite evidence of the benefits of exercise, people with Parkinson's disease (PD) often exercise less than recommended. We sought to identify exercise class-related factors associated with the amount of exercise in PD communities. METHODS We used Parkinson's Outcome Project (POP) data from 3146 people with PD at 19 participating Centers of Excellence (COEs). POP data included self-reported moderate-vigorous exercise (MVE) hours, light physical activity (PA) hours, demographic and disease severity variables. We also collected information about weekly exercise class availability, intensity, cost, and distance from class location to the COE. We examined differences between COE-based and community-based exercise classes using the Akritas test for paired and unpaired samples. We tested associations between class characteristics and exercise hours based on a two-part model: logistic regression on whether a participant does MVE or light PA and linear regression for log-transformed time of exercise. RESULTS Community-based exercise classes had a significantly higher weekly availability than COE-based classes (class hours per week: 47.5 ± 25.6 vs 6.5 ± 8.6, p < 0.001), a higher percentage of vigorous-intensity classes (24.2 ± 17.8 vs 11 ± 14.7, p < 0.001), and a broader geographic distribution (miles to COE: 12.8 ± 4.6 vs 6.2 ± 5.7, p < 0.001). Greater weekly hours of availability, intensity, and distance to COE were associated with increased MVE and light PA hours among participants who exercised (p < 0.01). Of these, higher weekly class availability explained the most variability in reported exercise hours. CONCLUSION Parkinson's COEs may be able to increase exercise by facilitating a high weekly availability of exercise classes with higher intensity levels and broader geographical distribution.
Collapse
Affiliation(s)
- Ella Nettnin
- Shirley Ryan AbilityLab, 355 E. Erie St. 19 Floor Lab, Chicago, IL 60611, USA
| | - Stephanie Burrows
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA
| | - Guanhong Miao
- Department of Biostatistics, University of Florida, 2004 Mowry Rd, Gainesville, FL 32611, USA
| | - Samuel S. Wu
- Department of Biostatistics, University of Florida, 2004 Mowry Rd, Gainesville, FL 32611, USA
| | - David K. Simon
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Miriam R. Rafferty
- Shirley Ryan AbilityLab, 355 E. Erie St. 19 Floor Lab, Chicago, IL 60611, USA
- Department of Physical Medicine & Rehabilitation and Department of Psychiatry and Behavioral Science, Feinberg School of Medicine, Northwestern University, 710 N. Lake Shore Dr., Chicago, IL 60611, USA
| | - on behalf of the Parkinson's Foundation – Quality Improvement Initiative Investigators see supporting materials
- Shirley Ryan AbilityLab, 355 E. Erie St. 19 Floor Lab, Chicago, IL 60611, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA
- Department of Biostatistics, University of Florida, 2004 Mowry Rd, Gainesville, FL 32611, USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
- Department of Physical Medicine & Rehabilitation and Department of Psychiatry and Behavioral Science, Feinberg School of Medicine, Northwestern University, 710 N. Lake Shore Dr., Chicago, IL 60611, USA
| |
Collapse
|
13
|
Alushi L, Alexander J, Jones J, Lafortune L. A Systematic Review on Physical Health Education Interventions for People with Parkinson's Disease: Content, Impact, and Implementation Considerations Across the Parkinson's Trajectory. JOURNAL OF PARKINSON'S DISEASE 2022; 12:1389-1407. [PMID: 35599500 DOI: 10.3233/jpd-223259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Educational interventions promoting the role of physical activity (PA) aim to address knowledge, poor exercise self-efficacy, and low outcome expectations, which are well-researched barriers to PA participation in healthy and in people with chronic conditions. However, little is known about the effectiveness of educational interventions in addressing these barriers in people with Parkinson's (PwP). OBJECTIVE To examine the content of education interventions that promote PA behavior in PwP, and to assess their effectiveness on physical and psychosocial outcomes. METHODS An electronic search (12/2021) of MEDLINE, EMBASE, CINAHL, PubMed PsycINFO, the Web of Science and the Cochrane Library was conducted from 1990 to 2021. Education interventions, alone or combined with other strategies, promoting PA in PwP were included. Quality was assessed using the Johanna Briggs Institute and National Institute of Health quality assessment tools. A narrative synthesis was performed. RESULTS Six studies were identified. Five interventions were comprised of education and exercise sessions. Improvement in physical and psychosocial outcomes were suggested but delineating the exact impact of education was impeded due to lack of assessment. CONCLUSION Few interventions exist that provide knowledge, and skills promoting PA participation, and fewer are addressed towards newly diagnosed PwP. There is lack of assessment over the effectiveness of education as a tool to facilitate PA participation in PwP. Lack of assessment poses the risk of potentially disregarding effective interventions or adopting ineffective approaches without the evidence. Education interventions can boost PA engagement by increasing factors such as exercise self-efficacy, but further interventions are required to assess this model of relationship.
Collapse
Affiliation(s)
- Ledia Alushi
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - James Alexander
- Centre for Applied Health & Social Care Research, Kingston & St George's, University of London, London, UK
- Camden Neurology & Stroke Service, Central and North West London NHS Foundation Trust, London, UK
| | - Julie Jones
- School of Health Sciences, Robert Gordon University, Aberdeen, Scotland
| | - Louise Lafortune
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Cambridge Public Health, Interdisciplinary Research Centre, University of Cambridge, Cambridge, UK
| |
Collapse
|
14
|
Elpidoforou M, Bakalidou D, Drakopoulou M, Kavga A, Chrysovitsanou C, Stefanis L. Effects of a structured dance program in Parkinson's disease. A Greek pilot study. Complement Ther Clin Pract 2021; 46:101528. [PMID: 34974325 DOI: 10.1016/j.ctcp.2021.101528] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/24/2021] [Accepted: 12/27/2021] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Dance for Parkinson's Disease® (DfPD®) is a structured dance program that has never been evaluated in Greek PD population. This study assesses for the first time the efficacy, safety and feasibility of DfPD® program in Greek PD patients. MATERIAL AND METHODS A total of 16 early-to-mid-stage PD patients (50% men, aged 56 ± 12) underwent a total of 16 60-min classes of adjusted to Greek music and dance culture DfPD®, twice weekly, over 8 weeks. Assessments were performed at baseline and at the end of the study period and included quality of life (PDQ-8), depressive symptoms (BDI-II), fatigue (PFS-16), cognitive functions (MoCA), balance (BBS) and body mass index (BMI). Safety (possible falls, injuries, muscle soreness or excessive fatigue) and feasibility (technical and financial parameters, willingness for participation and continuation, recruitment rates) were also assessed. RESULTS Statistically significant improvements were found in quality of life (29 ± 47%, p = 0,020), depressive symptoms (26 ± 52%, p = 0,046), fatigue (13 ± 20%, p = 0,021), cognitive functions (17 ± 23%, p = 0,010), balance (5 ± 4%, p = 0,003) and BMI (2 ± 2%, p = 0,010). No adverse events, high adherence (93,75%) and low attrition (12,5%) rates were reported. CONCLUSION A twice weekly 60-min DfPD® class for 8 weeks is a safe and feasible non-pharmacological complementary therapeutic intervention for Greek PD patients and may improve their quality of life, depressive symptoms, fatigue, cognitive functions, balance, and BMI. Further research on this intervention is warranted.
Collapse
Affiliation(s)
- Michail Elpidoforou
- Laboratory of Neuromuscular and Cardiovascular Study of Motion - LANECASM, Department of Physiotherapy, University of West Attica, Athens, Greece.
| | - Daphne Bakalidou
- Laboratory of Neuromuscular and Cardiovascular Study of Motion - LANECASM, Department of Physiotherapy, University of West Attica, Athens, Greece; Department of Physiotherapy, University of West Attica, Athens, Greece
| | - Maria Drakopoulou
- Department of Nursing, Community Nursing and Public Health Nursing Sector, University of West Attica, Athens, Greece
| | - Anna Kavga
- Department of Nursing, Community Nursing and Public Health Nursing Sector, University of West Attica, Athens, Greece
| | - Chrysa Chrysovitsanou
- 1st Department of Neurology, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Leonidas Stefanis
- 1st Department of Neurology, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
15
|
Zaman MS, Ghahari S, McColl MA. Barriers to Accessing Healthcare Services for People with Parkinson's Disease: A Scoping Review. JOURNAL OF PARKINSON'S DISEASE 2021; 11:1537-1553. [PMID: 34308913 PMCID: PMC8609702 DOI: 10.3233/jpd-212735] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/03/2021] [Indexed: 12/18/2022]
Abstract
Parkinson's disease is a complex condition that affects many different aspects of a person's health. Because of its complexity, people with Parkinson's disease require access to a variety of healthcare services. The aim of the present study was to identify the barriers to access healthcare services for people with Parkinson's disease. We conducted a scoping review according to guidelines posed by Arksey & O'Malley (2005). A search of MEDLINE, Embase, CINHAL, and PsycINFO databases was conducted, and 38 articles were selected based on the inclusion criteria. The review findings identified person-level and system-level barriers. The person-level barriers included skills required to seek healthcare services, ability to engage in healthcare and cost for services. The system-level barriers included the availability of appropriate healthcare resources. Based on the existing barriers elucidated in the scope review, we have discussed potential areas in healthcare that require improvement for people with Parkinson's disease to manage their healthcare needs more equitably.
Collapse
Affiliation(s)
| | - Setareh Ghahari
- School of Rehabilitation Therapy, Queen’s University, Kingston, Canada
| | - Mary Ann McColl
- School of Rehabilitation Therapy, Queen’s University, Kingston, Canada
| |
Collapse
|
16
|
"Keep Moving": Experiences of People With Parkinson's and Their Care Partners in a Dance Class. Adapt Phys Activ Q 2021; 38:307-328. [PMID: 33596544 DOI: 10.1123/apaq.2019-0125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 08/15/2020] [Accepted: 08/25/2020] [Indexed: 11/18/2022] Open
Abstract
The purpose of this study was to examine the experiences of people with Parkinson's (PwP) and their care partners (CPs) who participated in a Parkinson's-focused community dance class in a northeastern state of the United States. In this qualitative inquiry, participants included five PwP and their respective CPs (n = 5). Three major, recurrent, and interrelated themes emerged from the data. These themes were (a) keep moving, (b) compassion in action, and (c) acceptance and freedom in dance. These themes captured personal and environmental factors that influenced the participation of PwP and their CPs in a dance class and how they perceived that dance influenced their quality of life. The themes described the obstacles, motives, and perceived outcomes of participating in dance. The findings emphasize the need for future dance interventions and programs that consider the CPs' role in promoting participation for PwP in dance classes.
Collapse
|
17
|
Brunet J, Price J, Wurz A, McDonough M, Nantel J. Boxing with Parkinson's Disease: findings from a qualitative study using self-determination theory. Disabil Rehabil 2021; 44:3880-3889. [PMID: 33625954 DOI: 10.1080/09638288.2021.1891465] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE Adults with Parkinson's disease (PD) experience debilitating symptoms that may be mitigated by boxing. Yet, attrition from boxing programs is problematic. Understanding whether PD-specific boxing programs can enhance motivation to remain physically active is important. This study investigated adults' experiences within a PD-specific boxing program and explored their perspectives on how the program has influenced physical activity motivational processes using a self-determination theory (SDT) lens. Methods: Nine adults with PD who took part in the Boxing 4 Health PD-specific boxing program completed face-to-face, semi-structured interviews. Data were analyzed using a hybrid approach of inductive and deductive thematic analysis. Results: The analysis yielded five themes: (1) I made an informed decision to participate and it feels good, (2) Boxing helps me stay active and keep moving, (3) To keep me going, the boxing program needs to have variety and allow for input, (4) A program that can be adapted to me is important, and (5) The instructor and the group facilitate my continued participation in the program. Conclusion: Providing participants with adapted exercises, varied sessions, and opportunities to provide input in a group-based PD-specific boxing program may be conducive to enhancing motivation for physical activity. Further, SDT may be a useful theoretical framework for developing and evaluating PD-specific programs.IMPLICATIONS FOR REHABILITATIONAdults with Parkinson's disease (PD) have many reasons for not engaging in physical activity, including a lack of motivation.A group-based PD-specific boxing program may be conducive to increasing motivation for physical activity.Professionals should consider: (1) educating adults with PD on the benefits of boxing, (2) offering group-based PD-specific boxing programs that are adaptable, varied, and open to input, and (3) fostering social support and networking opportunities within such programs.
Collapse
Affiliation(s)
- Jennifer Brunet
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, Canada.,Cancer Therapeutic Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada.,Institut du savoir Montfort, Hôpital Montfort, Ottawa, Canada
| | - Jenson Price
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Amanda Wurz
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | | | - Julie Nantel
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, Canada
| |
Collapse
|
18
|
Ashburn A, Pickering R, McIntosh E, Hulbert S, Rochester L, Roberts HC, Nieuwboer A, Kunkel D, Goodwin VA, Lamb SE, Ballinger C, Seymour KC. Exercise- and strategy-based physiotherapy-delivered intervention for preventing repeat falls in people with Parkinson's: the PDSAFE RCT. Health Technol Assess 2020; 23:1-150. [PMID: 31339100 DOI: 10.3310/hta23360] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND People with Parkinson's disease are twice as likely to experience a fall as a healthy older person, often leading to debilitating effects on confidence, activity levels and quality of life. OBJECTIVE To estimate the effect of a physiotherapy programme for fall prevention among people with Parkinson's disease. DESIGN A multicentre, pragmatic, investigator-masked, individually randomised controlled trial (RCT) with prespecified subgroup analyses. SETTING Recruitment from NHS hospitals and clinics and community and social services in eight English regions with home-based interventions. PARTICIPANTS A total of 474 people with Parkinson's disease (i.e. Hoehn and Yahr scale stages 1-4) were recruited: 238 were assigned to a physiotherapy programme and 236 were assigned to usual care. Random allocation was 50 : 50. INTERVENTIONS All participants received routine care; the usual-care group received an information digital versatile disc (DVD) and a single advice session at trial completion. The intervention group had an individually tailored, progressive, home-based fall avoidance strategy training programme with balance and strengthening exercises: PDSAFE. MAIN OUTCOME MEASURES The primary outcome was the risk of repeat falling, collected by self-report monthly diaries between 0 and 6 months after randomisation. Secondary outcomes included near-falls, falls efficacy, freezing of gait (FoG), health-related quality of life, and measurements taken using the Mini-Balance Evaluation Systems Test (Mini-BESTest), the Chair Stand Test (CST), the Geriatric Depression Scale, the Physical Activity Scale for the Elderly and the Parkinson's Disease Questionnaire. RESULTS PDSAFE is the largest RCT of falls management among people with Parkinson's disease: 541 patients were screened for eligibility. The average age was 72 years, and 266 out of 474 (56%) participants were men. Of the 474 randomised participants, 238 were randomised to the intervention group and 236 were randomised to the control group. No difference in repeat falling within 6 months of randomisation was found [PDSAFE group to control group odds ratio (OR) 1.21, 95% confidence interval (CI) 0.74 to 1.98; p = 0.447]. An analysis of secondary outcomes demonstrated better balance (Mini-BESTest: mean difference 0.95, 95% CI 0.24 to 1.67; p = 0.009), functional strength (CST: p = 0.041) and falls efficacy (Falls Efficacy Scale - International: mean difference 1.6, 95% CI -3.0 to -0.19; p = 0.026) with near-falling significantly reduced with PDSAFE (OR 0.67, 95% CI 0.53 to 0.86; p = 0.001) at 6 months. Prespecified subgroup analysis (i.e. disease severity and FoG) revealed a PDSAFE differing effect; the intervention may be of benefit for people with moderate disease but may increase falling for those in the more severe category, especially those with FoG. LIMITATIONS All participants were assessed at primary outcome; only 73% were assessed at 12 months owing to restricted funding. CONCLUSIONS PDSAFE was not effective in reducing repeat falling across the range of people with Parkinson's disease in the trial. Secondary analysis demonstrated that other functional tasks and self-efficacy improved and demonstrated differential patterns of intervention impact in accordance with disease severity and FoG, which supports previous secondary research findings and merits further primary evaluation. FUTURE WORK Further trials of falls prevention on targeted groups of people with Parkinson's disease are recommended. TRIAL REGISTRATION Current Controlled Trials ISRCTN48152791. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 36. See the NIHR Journals Library website for further project information. Sarah E Lamb is funded by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) at Oxford Health NHS Foundation Trust, the NIHR Oxford Biomedical Research Centre at the Oxford University Hospitals NHS Foundation Trust and CLAHRC Oxford. Victoria A Goodwin is supported by the NIHR Collaborations for Leadership in Applied Health Research and Care in the South West Peninsula (PenCLAHRC). Lynn Rochester is supported by the NIHR Newcastle Biomedical Research Centre based at Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University. The research was also supported by the NIHR Newcastle Clinical Research Facility Infrastructure funding. Helen C Roberts is supported by CLAHRC Wessex and the NIHR Southampton Biomedical Research Centre.
Collapse
Affiliation(s)
- Ann Ashburn
- Faculty of Health Science, University of Southampton, Southampton, UK
| | - Ruth Pickering
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Sophia Hulbert
- Faculty of Health Science, University of Southampton, Southampton, UK
| | - Lynn Rochester
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Helen C Roberts
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Alice Nieuwboer
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Dorit Kunkel
- Faculty of Health Science, University of Southampton, Southampton, UK
| | | | - Sarah E Lamb
- Oxford Clinical Trials Research Unit, University of Oxford Medical Sciences Division, Oxford, UK
| | - Claire Ballinger
- Wessex Public Involvement Network (PIN), University of Southampton, Southampton General Hospital, Southampton, UK
| | | |
Collapse
|
19
|
Hunter H, Lovegrove C, Haas B, Freeman J, Gunn H. Experiences of people with Parkinson's disease and their views on physical activity interventions: a qualitative systematic review. ACTA ACUST UNITED AC 2020; 17:548-613. [PMID: 30973527 DOI: 10.11124/jbisrir-2017-003901] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of the review was to synthesize the best available qualitative evidence on the experiences and preferences of people with Parkinson's disease for physical activity, their perceived motivators and barriers to engagement, as well as their views on support mechanisms and behavior change interventions designed to sustain participation. INTRODUCTION National and international guidelines recommend regular physical activity to improve health and wellbeing and to prevent disease. Research on Parkinson's disease indicates that physical activity programs can be beneficial in addressing both physical symptoms and overall wellbeing. However, despite recommendations, sustained engagement in regular physical activity among people with Parkinson's disease is limited. To promote physical activity it is important to understand their perspectives on this topic. INCLUSION CRITERIA This review considered studies that included a qualitative evaluation of the experiences and views of people with Parkinson's disease regarding physical activity and interventions designed to sustain participation. METHODS The databases MEDLINE, Embase, CINAHL, AMED, Scopus and Web of Science, and unpublished studies in sources of grey literature (Google, OpenGrey, MedNar, Conference Paper Index, PQDT) were searched. Language limiters were restricted to English and dates ranged from the inception of the database to June 30, 2017. Two reviewers assessed studies that met the inclusion criteria independently, using the criteria of the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. One reviewer completed data extraction using the standardized qualitative data extraction tool. This was checked for accuracy by a second reviewer. The qualitative research findings were pooled using JBI methodology. The JBI process of meta-aggregation was used to identify categories and synthesized findings. RESULTS Nineteen studies were included in this review following assessment of the methodological quality of each study. Two studies were excluded after the methodological review as the findings were not supported by illustrations of the participant voice. Subsequently, 105 findings were extracted and aggregated into 20 categories and eight synthesized findings. Methodological quality was variable and overall confidence in the findings was determined to be low. CONCLUSION This review revealed that people with Parkinson's disease viewed physical activity as an enjoyable and positive experience, which aided with control of their symptoms and enhanced their wellbeing and quality of life. Aligned with evidence from older adults and those with long-term conditions, this review identified disease presentation, intrapersonal characteristics, program design, external support and the social and physical environment as contributory factors which influenced the ability of people with Parkinson's disease to sustain engagement in physical activity. The unique contribution and weighting of these factors will affect an individual's participation in physical activity. This review provides important insights into the challenges of undertaking physical activity while living with a progressive and fluctuating disease. These qualitative findings give healthcare providers an insight into the views and experiences of people with Parkinson's disease and are useful, alongside quantitative evidence of effectiveness, for the design of physical activity programs that are meaningful for this population. However, a limitation of this review is that it does not address the views and experiences of people with Parkinson's disease who are inactive.
Collapse
Affiliation(s)
- Heather Hunter
- School of Health Professions, Plymouth University, Plymouth, United Kingdom.,The University of Plymouth Centre for Innovations in Health and Social Care: a Joanna Briggs Institute Centre of Excellence
| | | | - Bernhard Haas
- School of Health Professions, Plymouth University, Plymouth, United Kingdom
| | - Jennifer Freeman
- School of Health Professions, Plymouth University, Plymouth, United Kingdom.,The University of Plymouth Centre for Innovations in Health and Social Care: a Joanna Briggs Institute Centre of Excellence
| | - Hilary Gunn
- School of Health Professions, Plymouth University, Plymouth, United Kingdom
| |
Collapse
|
20
|
Rowsell A, Ashburn A, Fitton C, Goodwin VA, Hulbert S, Lamb SE, McIntosh E, Nieuwboer A, Pickering R, Rochester L, Chivers-Seymour K, Ballinger C. Participant expectations and experiences of a tailored physiotherapy intervention for people with Parkinson's and a history of falls. Disabil Rehabil 2020; 44:727-735. [PMID: 32573284 DOI: 10.1080/09638288.2020.1779824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: People with Parkinson's are twice as likely to fall as older people within the general population. This longitudinal qualitative study was part of a larger programme of research including a randomised controlled trial to test the effectiveness of a tailored physiotherapy intervention. Specific qualitative aims focused on a subsample of trial participants in the intervention arm of the trial, and comprised the following:To explore the expectations of participants about the intervention.To investigate participants' experiences of the intervention, and its perceived impacts.To understand the facilitators and barriers to engagement.Methods: Two semi-structured interviews were completed with a theoretical sample of people with Parkinson's from the intervention arm, initially after randomisation but before the intervention commenced, and then again six months later.Results: Forty-two participants out of a large clinical trial were interviewed initially, with 37 agreeing to a second interview at six months. Prior experience of rehabilitation plus information accessed through the trial consent procedure informed participants' realistic expectations. Most found the level of the intervention acceptable, and perceived a range of benefits. However, views about equipment provided were more equivocal. The biggest barriers to participation were time and motivation, whilst social support facilitated engagement with the intervention.Conclusions: This study is the first to capture expectations about participation in a programme of exercises and strategies. It highlights that previous challenges to engagement in physical exercises and activities are not a barrier to future participation and provides new insights into the role of equipment and technology in programmes of physical activity for people with Parkinson's. The challenge of ensuring that programmes of exercise and strategies become an embedded feature of everyday life is highlighted, particularly alongside busy social engagements and leisure pursuits.Implications for rehabilitationFor people with Parkinsons, a programme of exercises and strategies has the potential to reduce the risk of falls amongst those with a history of falling.Adherence to such programmes can prove challenging for a variety of reasons, even when participants have realistic expectations about the commitment and effort needed.Clear explanations about the role of equipment and technology within such programmes could enhance adherence.In order to further individualise programmes of exercise for people with Parkinsons, choice regarding social support, reminders and integration into everyday activities should be explored.
Collapse
Affiliation(s)
- Alison Rowsell
- Health Sciences, University of Southampton, Southampton, UK
| | - Ann Ashburn
- Health Sciences, University of Southampton, Southampton, UK
| | - Carolyn Fitton
- Health Sciences, University of Southampton, Southampton, UK
| | | | | | - Sarah E Lamb
- Institute for Health Research, University of Exeter, Exeter, UK
| | - Emma McIntosh
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alice Nieuwboer
- Rehabilitation Sciences, University of Leuven, Leuven, Belgium
| | - Ruth Pickering
- Biomedical Research Centre, University of Southampton, Southampton, UK
| | - Lynn Rochester
- Translational and Clinical Research Institute, University of Newcastle, Newcastle, UK
| | | | - Claire Ballinger
- Biomedical Research Centre, University of Southampton, Southampton, UK
| |
Collapse
|
21
|
Carlozzi NE, Boileau NR, Chou KL, Ready RE, Cella D, McCormack MK, Miner JA, Dayalu P. HDQLIFE and neuro-QoL physical function measures: Responsiveness in persons with huntington's disease. Mov Disord 2019; 35:326-336. [PMID: 31724237 DOI: 10.1002/mds.27908] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 09/26/2019] [Accepted: 10/04/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Huntington's disease (HD) is a neurological disorder that causes severe motor symptoms that adversely impact health-related quality of life. Patient-reported physical function outcome measures in HD have shown cross-sectional evidence of validity, but responsiveness has not yet been assessed. OBJECTIVES This study evaluates the responsiveness of the Huntington Disease Health-Related Quality of Life (HDQLIFE) and the Quality of Life in Neurological Disorders (Neuro-QoL) physical function measures in persons with HD. METHODS A total of 347 participants completed baseline and at least 1 follow-up (12-month and 24-month) measure (HDQLIFE Chorea, HDQLIFE Swallowing Difficulties, HDQLIFE Speech Difficulties, Neuro-QoL Upper Extremity Function, and/or Neuro-QoL Lower Extremity Function). Of the participants that completed the baseline assessment, 338 (90.9%) completed the 12-month assessment, and 293 (78.8%) completed the 24-month assessment. Standardized response means and general linear models evaluated whether the physical function measures were responsive to self-reported and clinician-rated change over time. RESULTS Small to moderate effect sizes for the standardized response means supported 12-month and 24-month responsiveness of the HDQLIFE and Neuro-QoL measures for those with either self-reported or clinician-rated declines in function. General linear models supported 12-month and 24-month responsiveness for all HRQOL measures relative to self-reported declines in health, but generally only 24-month responsiveness was supported relative to clinician-rated declines in function. CONCLUSIONS Longitudinal analyses indicate that the HDQLIFE and the Neuro-QoL physical function measures are sensitive to change over time in individuals with HD. Thus, these scales exhibit evidence of responsiveness and may be useful outcome measures in future clinical trials. © 2019 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicholas R Boileau
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Kelvin L Chou
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Rebecca E Ready
- Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, Massachusetts, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael K McCormack
- Department of Psychiatry, Rutgers University-Robert Wood Johnson Medical School, Piscataway, New Jersey, USA.,Department of Pathology, Rowan University-SOM (School of Medicine), Stratford, New Jersey, USA
| | - Jennifer A Miner
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Praveen Dayalu
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
22
|
Jones U, Hamana K, Vougioukalou S, Jones M, Busse M. Exploration of a Co-Production Approach to Developing a Walking Group with People with Huntington's Disease. MED ONE 2019; 4:e190022. [PMID: 31720375 PMCID: PMC6850910 DOI: 10.20900/mo.20190022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND People with Huntington's disease (HD) struggle to maintain regular physical activity despite evidence of the benefits of exercise. This study aimed to evaluate the experiences of people who co-produced a walking group for people with HD. METHODS Three people with HD, a specialist HD advisor (sHDA), two project officers from Let's Walk Cymru (LWC) and the research team co-produced and participated in a walking group for people with HD. A walking group for people with HD was supported weekly by LWC for eight weeks and fortnightly for a further 12 weeks. Semi-structured interviews were undertaken with three people with HD, a sHDA and two project LWC project officers. Interviews were transcribed verbatim and analysed using thematic analysis. FINDINGS Interviews identified six themes across participants: "organisation and planning"; "purpose of the walks"; "benefits"; "barriers", "the group" and "the future". People with HD enjoyed participating in the walks and reported increased confidence to be more active outside the home. All participants noted challenges including apathy, diminished planning skills, social stigma and motor problems specific to HD; people with HD perceived a lack of influence in relation to co-planning and co-execution of the walking group. CONCLUSIONS The walking group was perceived as enjoyable, beneficial, and motivational. This is the first study to report co-production of a walking group with people with HD and the findings suggest that further research is needed to adapt models of co-production for people with a long-term complex condition.
Collapse
Affiliation(s)
- Una Jones
- School of Healthcare Sciences, Cardiff University, Heath Park, Cardiff CF14 4XN, UK
| | - Katy Hamana
- School of Healthcare Sciences, Cardiff University, Heath Park, Cardiff CF14 4XN, UK
| | - Sofia Vougioukalou
- School of Healthcare Sciences, Cardiff University, Heath Park, Cardiff CF14 4XN, UK
| | - Mel Jones
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Llandaff Campus, Cardiff CF5 2YB, UK
| | - Monica Busse
- Centre for Trials Research, Cardiff University, Neuadd Merionnydd, Heath Park, Cardiff CF14 4XN, UK
| |
Collapse
|
23
|
Hamana K, Quinn L, Gambling T, Busse M. An exploration of physical activity experiences throughout the Huntington's disease journey: supporting development of theoretically underpinned complex interventions. Disabil Rehabil 2019; 43:1565-1575. [PMID: 31588808 DOI: 10.1080/09638288.2019.1671501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE Huntington's disease is an autosomal dominant neurodegenerative disease. Progressive physical, behavioural and cognitive impairments cause loss of independent function. Physical activity interventions are important components of comprehensive intervention strategies and may help alter the functional decline trajectory. Qualitative research has an important role to play in developing theoretically sound, well-defined physical activity interventions in Huntington's disease. MATERIALS AND METHODS Eight focus groups were conducted with people with prodromal to late stage Huntington's disease, caregivers (family members/formal), and healthcare professionals. An analytical coding framework was developed from the data and Levanthal's self-regulation model to assist analysis. RESULTS AND CONCLUSIONS Key themes were identified: evolving representations of Huntington's disease and physical activity; varying social environment of the person with Huntington's disease and the impact on physical activity; achieving physical activity participation while coping with the nuances of Huntington's disease. Levanthal's model facilitated understanding of physical activity experiences, however with progression, self-regulation of activities needs to become more collaborative with caregivers. A modified self-regulation model specific to physical activity in Huntington's disease is presented. Using a novel approach to generate new understanding of physical activity across the Huntington's disease lifespan facilitated development of an original and significant theoretical foundation to underpin development of a range of much needed physical activity and exercise interventions in Huntington's disease.Implications for rehabilitationSocial and familial context of individuals with HD is a key consideration for health care professionals supporting physical activity participation.Strategies such as using physical activity as a way of achieving control and adjusting expectations can help people with HD to continue to be active.People with HD adapt physical activity from high level to more functional activities with symptom progression.
Collapse
Affiliation(s)
- Katy Hamana
- School of Healthcare Sciences, Cardiff University, Cardiff, Wales
| | - Lori Quinn
- Teachers College, Columbia University, New York, NY, USA
| | - Tina Gambling
- School of Healthcare Sciences, Cardiff University, Cardiff, Wales
| | - Monica Busse
- Centre for Trials Research, Cardiff University, Cardiff, Wales
| |
Collapse
|
24
|
Drew CJG, Quinn L, Hamana K, Williams-Thomas R, Marsh L, Dimitropoulou P, Playle R, Griffin BA, Kelson M, Schubert R, Muratori L, Reilmann R, Rosser A, Busse M. Physical Activity and Exercise Outcomes in Huntington Disease (PACE-HD): Protocol for a 12-Month Trial Within Cohort Evaluation of a Physical Activity Intervention in People With Huntington Disease. Phys Ther 2019; 99:1201-1210. [PMID: 31101920 DOI: 10.1093/ptj/pzz075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 02/18/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND Exercise is emerging as an important aspect in the management of disease-related symptoms and functional decline in people with Huntington disease (HD). Long-term evaluation of physical activity and exercise participation in HD has yet to be undertaken. OBJECTIVE The objective is to investigate the feasibility of a nested randomized controlled trial (RCT) alongside a longitudinal observational study of physical activity and exercise outcomes in people with HD. DESIGN This will be a 12-month longitudinal observational study (n = 120) with a nested evaluation of a physical activity intervention (n = 30) compared with usual activity (n = 30) using a "trial within a cohort" design. SETTING The study will take place in HD specialist clinics in Germany, Spain, and the United States, with intervention delivery in community settings. PARTICIPANTS The participants will have early-mid-stage HD and be participating in the Enroll-HD study. INTERVENTION This will be a 12-month physical activity behavioral change intervention, delivered by physical therapists in 18 sessions, targeting uptake of aerobic exercise and increased physical activity. MEASUREMENTS All participants (n = 120) will complete Enroll-HD assessments (motor, cognitive, behavioral, and quality of life) at baseline and at 12 months. Additional Physical ACtivity and Exercise Outcomes in Huntington Disease (PACE-HD) assessments include fitness (predicted maximal oxygen uptake [V o2max]), self-reported and quantitative measures of physical activity, disease-specific symptoms, and walking endurance. RCT participants (n = 60) will complete an additional battery of quantitative motor assessments and a 6-month interim assessment. Enroll-HD data will be linked to PACE-HD physical activity and fitness data. LIMITATIONS The limitations include that the embedded RCT is open, and assessors at RCT sites are not blinded to participant allocation. CONCLUSION PACE-HD will enable determination of the feasibility of long-term physical activity interventions in people with HD. The novel "trial within a cohort" design and incorporation of data linkage have potential to reduce participant burden. This design could be applied to other neurological diseases and movement disorders where recruitment and retention are challenging.
Collapse
Affiliation(s)
- Cheney J G Drew
- Centre for Trials Research, Cardiff University, South Glamorgan, United Kingdom
| | - Lori Quinn
- Centre for Trials Research, Cardiff University; and Teachers College, Columbia University, New York, New York
| | - Katy Hamana
- School of Health Care Sciences, Cardiff University
| | | | - Lucy Marsh
- Centre for Trials Research, Cardiff University, South Glamorgan, United Kingdom
| | | | - Rebecca Playle
- Centre for Trials Research, Cardiff University, South Glamorgan, United Kingdom
| | | | - Mark Kelson
- Department of Mathematics, University of Exeter, Exeter, United Kingdom
| | - Robin Schubert
- George Huntington Institute and Institute for Clinical Radiology, University of Münster, Münster, Germany
| | - Lisa Muratori
- George Huntington Institute and Institute for Clinical Radiology, University of Münster; and School of Health Technology and Management, Stony Brook University, Stony Brook, New York
| | - Ralf Reilmann
- George Huntington Institute and Institute for Clinical Radiology, University of Münster; and Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | | | - Monica Busse
- Centre for Trials Research, Cardiff University, 4th Floor, Neuadd Meirionydd Health Park, Cardiff, South Glamorgan CF14 7YS, United Kingdom
| |
Collapse
|
25
|
Müller MLTM, Marusic U, van Emde Boas M, Weiss D, Bohnen NI. Treatment options for postural instability and gait difficulties in Parkinson's disease. Expert Rev Neurother 2019; 19:1229-1251. [PMID: 31418599 DOI: 10.1080/14737175.2019.1656067] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Introduction: Gait and balance disorders in Parkinson's disease (PD) represent a major therapeutic challenge as frequent falls and freezing of gait impair quality of life and predict mortality. Limited dopaminergic therapy responses implicate non-dopaminergic mechanisms calling for alternative therapies.Areas covered: The authors provide a review that encompasses pathophysiological changes involved in axial motor impairments in PD, pharmacological approaches, exercise, and physical therapy, improving physical activity levels, invasive and non-invasive neurostimulation, cueing interventions and wearable technology, and cognitive interventions.Expert opinion: There are many promising therapies available that, to a variable degree, affect gait and balance disorders in PD. However, not one therapy is the 'silver bullet' that provides full relief and ultimately meaningfully improves the patient's quality of life. Sedentariness, apathy, and emergence of frailty in advancing PD, especially in the setting of medical comorbidities, are perhaps the biggest threats to experience sustained benefits with any of the available therapeutic options and therefore need to be aggressively treated as early as possible. Multimodal or combination therapies may provide complementary benefits to manage axial motor features in PD, but selection of treatment modalities should be tailored to the individual patient's needs.
Collapse
Affiliation(s)
- Martijn L T M Müller
- Functional Neuroimaging, Cognitive and Mobility Laboratory, Department of Radiology, University of Michigan, Ann Arbor, MI, USA.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, USA
| | - Uros Marusic
- Institute for Kinesiology Research, Science and Research Centre of Koper, Koper, Slovenia.,Department of Health Sciences, Alma Mater Europaea - ECM, Maribor, Slovenia
| | - Miriam van Emde Boas
- Functional Neuroimaging, Cognitive and Mobility Laboratory, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Daniel Weiss
- Centre for Neurology, Department for Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Nicolaas I Bohnen
- Functional Neuroimaging, Cognitive and Mobility Laboratory, Department of Radiology, University of Michigan, Ann Arbor, MI, USA.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, USA.,Geriatric Research Education and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Neurology, University of Michigan, Ann Arbor, USA
| |
Collapse
|
26
|
Zaman A, Ellingson L, Sunken A, Gibson E, Stegemöller EL. Determinants of exercise behaviour in persons with Parkinson's disease. Disabil Rehabil 2019; 43:696-702. [PMID: 31322434 DOI: 10.1080/09638288.2019.1638975] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Exercise shows promise for improving physical and cognitive functioning, quality of life, and mood in individuals with Parkinson's disease (PD). Structured interviews have suggested potential factors influencing participation in exercise in this population, but no studies have examined if they predict exercise behaviour. METHODS Thirty persons with PD completed the International Physical Activity Questionnaire and a semi-structured interview. Time spent exercising was calculated by summing responses for recreation, sport, and leisure-time physical activity. Predictors of exercise were assessed via interview. In addition, participants were asked about what types of exercise they engaged in and what types of exercise they would be interested in trying. Regression analyses were used to identify the factors that predicted time spent exercising, as well as determining factors in low vs. high exercisers (≥150 min per week). RESULTS Positive predictors of exercise were being male (β= -0.52, p = 0.01; χ2 = 4.84, p = 0.03), married (β = 0.32, p = 0.03; χ2 = 5.60, p = 0.02), and enjoyment of exercise (β = 0.36, p = 0.02). Fear of falling (β = -0.41, p = 0.01; χ2 = 4.29, p = 0.04), negative perception of health (β = -0.41, p = 0.02), perception of PD symptoms (χ2 = 12.45, p < 0.001), bad weather (χ2 = 5.06, p = 0.02), and lack of an exercise partner (χ2 = 13.39, p < 0.001) were negative predictors of exercise. CONCLUSIONS Results from this study suggest that exercise programmes should work to make activities enjoyable, safe, and adaptable to the abilities of the individual. Programmes should also include social engagement.Implications for rehabilitationParkinson's exercise programmes should be enjoyable.Parkinson's exercise programmes should include both social engagement and social support.Parkinson's exercise programmes should be safe and adaptable to the abilities of the participants.Parkinson's exercise programmes should aim to improve balance and reduce fear of falling.Individual exercise programmes can also be successful, many people with PD exercise alone with the most common form being walking.
Collapse
Affiliation(s)
- Andrew Zaman
- Department of Kinesiology, Iowa State University, Ames, IA, USA
| | - Laura Ellingson
- Department of Kinesiology, Iowa State University, Ames, IA, USA
| | - Alyssa Sunken
- Department of Kinesiology, Iowa State University, Ames, IA, USA
| | - Erin Gibson
- Department of Kinesiology, Iowa State University, Ames, IA, USA
| | | |
Collapse
|
27
|
Yomtoob J, Yeh C, Bega D. Ancillary Service Utilization and Impact in Huntington's Disease. J Huntingtons Dis 2019; 8:301-310. [PMID: 31177235 DOI: 10.3233/jhd-190349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Prior Huntington's disease (HD) studies suggest ancillary services improve motor symptoms, cognition, mood, and quality of life but frequency of use and clinicalcharacteristics are unclear. OBJECTIVE Describe ancillary service utilization in a cohort of individuals with HD and determine which participant characteristics are associated with ancillary service utilization. METHODS Retrospective cross-sectional analysis of Enroll-HD database. Participants were grouped by therapy: physical and/or occupational (PT/OT), psychotherapy and/or counseling (PC), speech and/or swallowing (ST). We performed bivariate comparisons analysis of demographic and disease characteristics between those with/without each therapy and to analyze one-year mean change in assessment scores. RESULTS Of 4751 participants, 1537 (32.35%) utilized therapies (11.82% PT/OT, 5.33% PC, 3.01% ST, 1.98% all three, 10.21% two therapies). PT/OT participants had worse motor and functional scores: mean UHDRS motor score (41.17 vs. 38.05, p = 0.002), median total functional capacity score (TFC) (8.00 vs. 9.00, p < 0.001). PC participants had worse mood but better cognitive and functional scores: median depression score (7.00 vs. 2.00, p < 0.001), median MMSE (28.00 vs. 26.00, p < 0.001), median TFC (10.00 vs. 8.00, p < 0.001). ST participants had more dysarthria, and worse cognitive and functional scores: dysarthria (32.2% vs. 20.1% p < 0.001), mean correct Symbol Digit Modality Test (16.79 vs. 23.27, p < 0.001), median TFC (6.00 vs. 9.00, p < 0.001). Over one year, PC participants' depression scores improved compared to untreated (- 1.24 vs. - 0.11, p = 0.040). ST participants' depression scores worsened (1.14 vs. - 0.23, p = 0.044). Mean change in TFC was not significant for any therapies. CONCLUSIONS Only 32% of Enroll-HD site participants received ancillary services. Use correlated with expected clinical characteristics, though impact of use remains unclear.
Collapse
Affiliation(s)
- Jacob Yomtoob
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Chen Yeh
- Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Danny Bega
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
28
|
Shields N, Bruder AM, Cleary SL. An exploratory content analysis of how physiotherapists perceive barriers and facilitators to participation in physical activity among adults with disability. Physiother Theory Pract 2019; 37:149-157. [PMID: 31172868 DOI: 10.1080/09593985.2019.1623957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To explore the perceived barriers and facilitators to participation in physical activity among adults with disability, from the perspective of physiotherapists. Method: A convenience sample of 20 participants recruited from delegates attending a symposium at the 2015 Australian Physiotherapy Association conference. The participants completed a brief questionnaire. Content analysis was completed using an inductive approach. Results: Participants reported 18 facilitators and 18 barriers to participation in physical activity among adults with disability. The top five reported facilitators were as follows: having support (n = 17 responses), having a choice of opportunities (n = 10 responses), access to suitable venues and equipment (n = 10 responses), enjoying physical activity (n = 8 responses), and high self-efficacy (n = 7 responses). The top five reported barriers were as follows: reduced access to programs and opportunities (n = 15 responses), lack of support or social isolation (n = 14 responses), lack of transport (n = 7 responses), financial strain (n = 7 responses), and physical ability (n = 7 responses). Conclusions: Physiotherapists who have a strong interest in the physical activity habits of adults with disabilities recognize a wide range of facilitators and barriers to their participation. Psychosocial beliefs and behaviors (i.e., self-efficacy, motivation, fear, and attitude) of adults with disability might be more important influencers of physical activity participation than impairments of body structure and function.
Collapse
Affiliation(s)
- Nora Shields
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, Health Sciences 3, La Trobe University , Bundoora, Australia
| | - Andrea M Bruder
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, Health Sciences 3, La Trobe University , Bundoora, Australia
| | - Stacey L Cleary
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, Health Sciences 3, La Trobe University , Bundoora, Australia
| |
Collapse
|
29
|
Sherman CW, Iyer R, Abler V, Antonelli A, Carlozzi NE. Perceptions of the impact of chorea on health-related quality of life in Huntington disease (HD): A qualitative analysis of individuals across the HD spectrum, family members, and clinicians. Neuropsychol Rehabil 2019; 30:1150-1168. [PMID: 30849283 DOI: 10.1080/09602011.2018.1564675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Chorea, a hallmark symptom of Huntington's disease (HD), is characterized by jerky involuntary movements affecting the whole body that can interfere with daily functioning and impact health-related quality of life (HRQOL). To characterize chorea's impact on everyday functioning and HRQOL and identify patterns of perception and experiences of chorea among patients, caregivers, and providers. Data from focus groups of individuals with manifest HD (n = 8 early-stage HD; n = 16 late-stage HD), individuals at-risk or prodromal HD (n = 16), family HD caregivers (n = 17), and HD clinicians (n = 25). Focus group recordings were transcribed verbatim and analysed via constant comparison to identify meaningful and salient themes of living with chorea. Global themes of chorea's impact identified included: watching for chorea, experiences of stigma, and constraints on independence and relationships. Themes distinct to specific respondent groups included: Vigilance (at risk, prodromal); adaptation to chorea (early-stage); loss of autonomy and social life (late-stage); monitoring engagement (family caregivers) and safety (clinical providers). Living with chorea significantly constrains daily functioning, interactions, and HRQOL across the HD disease spectrum. Addressing these impacts via appropriate management of chorea can potentially enhance functioning, HRQOL, and overall satisfaction for persons with HD and their families.
Collapse
Affiliation(s)
| | - Ravi Iyer
- Teva Pharmaceutical Industries, Frazer, PA, USA
| | | | | | - Noelle E Carlozzi
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
30
|
de Oliveira Braga H, Gregório EC, Myra RS, de Souza ASK, Kunh TV, Klug J, de Azevedo Guimarães AC, Swarowsky A. EMPOWER-PD - A physical therapy intervention to empower the individuals with Parkinson's disease: a study protocol for a feasibility randomized controlled trial. Pilot Feasibility Stud 2019; 5:19. [PMID: 30705760 PMCID: PMC6348670 DOI: 10.1186/s40814-019-0394-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 01/03/2019] [Indexed: 11/24/2022] Open
Abstract
Background One of the greatest barriers found by physical therapy treating individuals with Parkinson’s disease (PD) is the adherence to treatment, associated with the lack of motivation to remain active. Therefore, there is a need to change the look given to physical therapy and for the individual, seeking the centralization of the therapy in their preferences. This study aims to present the EMPOWER-PD, a protocol based on individual preferences and its design for feasibility. Method A 12-week pilot for a randomized clinical trial will assess the feasibility and preliminary effectiveness of the EMPOWER-PD and make comparisons with conventional physical therapy (CPh). Both protocols consist of mobility and locomotion training, and aim at improving motor and non-motor symptoms through different approaches. The EMPOWER-PD aims to provide a source of motivation and empowerment of health through the self-knowledge of the individual’s abilities and limitations, in a protocol that addresses individual preferences. The CPh is based only on physiotherapist decisions, not addressing the individual’s preferences or motivation/empowerment. The target recruitment will be 24 PD individuals, between stages I and III of Hoehn and Yahr (HY), who will be recruited from Brazilian Parkinson’s disease Rehabilitation Initiative (BPaRkI) with allocation ratio 1:1. A computerized block randomization procedure will be implemented by a blinded researcher with the participants blinded to group assignment. The sessions will be conducted in a group setting, twice a week, during 60 min for 8 weeks, followed by 4 weeks of follow-up. The primary outcomes will be the feasibility data (adherence, recruitment rate, and safety). The secondary outcomes will assess the preliminary efficacy on qualitative assessment about individual’s motivation/empowerment and quantitative motor outcomes (Timed Up and Go and Dynamic Gait Index) and non-motor symptoms (6-min walk test and Fatigue Severity Scale). The recommendation to have 6–12 participants per group will be adopted based on the qualitative analysis to the sample size. Discussion This study will provide important insights about the physical therapy approach in PD individuals. The EMPOWER-PD is innovative because (1) it proposes an intervention that includes an individual-centered approach with motor control principles; (2) it aims to provide a source of motivation and empowerment of health; (3) assesses the individual in a global view considering motor and non-motor symptoms, using both, qualitative and quantitative metrics. Trial registration RBR-7ZBXQ5 Electronic supplementary material The online version of this article (10.1186/s40814-019-0394-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Helena de Oliveira Braga
- Brazilian Parkinson's Disease Rehabilitation Initiative (BPaRkI). Physical Therapy Postgraduate Program, Physical Therapy Department, Santa Catarina State University (UDESC), Center for Health and Sport Sciences (CEFID), Rua Pascoal Simone, 358, Coqueiros, Florianópolis, Santa Catarina 88080-350 Brazil
| | - Elaine Cristina Gregório
- Brazilian Parkinson's Disease Rehabilitation Initiative (BPaRkI). Physical Therapy Postgraduate Program, Physical Therapy Department, Santa Catarina State University (UDESC), Center for Health and Sport Sciences (CEFID), Rua Pascoal Simone, 358, Coqueiros, Florianópolis, Santa Catarina 88080-350 Brazil
| | - Rafaela Simon Myra
- Brazilian Parkinson's Disease Rehabilitation Initiative (BPaRkI). Physical Therapy Postgraduate Program, Physical Therapy Department, Santa Catarina State University (UDESC), Center for Health and Sport Sciences (CEFID), Rua Pascoal Simone, 358, Coqueiros, Florianópolis, Santa Catarina 88080-350 Brazil
| | - Ana Sofia Kauling de Souza
- Brazilian Parkinson's Disease Rehabilitation Initiative (BPaRkI). Physical Therapy Postgraduate Program, Physical Therapy Department, Santa Catarina State University (UDESC), Center for Health and Sport Sciences (CEFID), Rua Pascoal Simone, 358, Coqueiros, Florianópolis, Santa Catarina 88080-350 Brazil
| | - Talita Vitorina Kunh
- Brazilian Parkinson's Disease Rehabilitation Initiative (BPaRkI). Physical Therapy Postgraduate Program, Physical Therapy Department, Santa Catarina State University (UDESC), Center for Health and Sport Sciences (CEFID), Rua Pascoal Simone, 358, Coqueiros, Florianópolis, Santa Catarina 88080-350 Brazil
| | - Jessica Klug
- Brazilian Parkinson's Disease Rehabilitation Initiative (BPaRkI). Physical Therapy Postgraduate Program, Physical Therapy Department, Santa Catarina State University (UDESC), Center for Health and Sport Sciences (CEFID), Rua Pascoal Simone, 358, Coqueiros, Florianópolis, Santa Catarina 88080-350 Brazil
| | - Adriana Coutinho de Azevedo Guimarães
- Brazilian Parkinson's Disease Rehabilitation Initiative (BPaRkI). Physical Therapy Postgraduate Program, Physical Therapy Department, Santa Catarina State University (UDESC), Center for Health and Sport Sciences (CEFID), Rua Pascoal Simone, 358, Coqueiros, Florianópolis, Santa Catarina 88080-350 Brazil
| | - Alessandra Swarowsky
- Brazilian Parkinson's Disease Rehabilitation Initiative (BPaRkI). Physical Therapy Postgraduate Program, Physical Therapy Department, Santa Catarina State University (UDESC), Center for Health and Sport Sciences (CEFID), Rua Pascoal Simone, 358, Coqueiros, Florianópolis, Santa Catarina 88080-350 Brazil
| |
Collapse
|
31
|
Jackson K, Hamilton S, Jones S, Barr S. Patient reported experiences of using community rehabilitation and/or support services whilst living with a long-term neurological condition: a qualitative systematic review and meta-aggregation. Disabil Rehabil 2018; 41:2731-2749. [PMID: 29911901 DOI: 10.1080/09638288.2018.1473508] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objectives: The objective of this study is to identify patient reported experiences of using community rehabilitation and/or support services whilst living with a long-term neurological condition, and perceptions of their impact on quality of life.Methods: Nine electronic databases were searched for peer-reviewed qualitative studies from 2005 to 2016, which met the inclusion criteria. Critical appraisal, data extraction, and quality assessment of 37 included papers were performed by three reviewers. One hundred and one findings were extracted. Meta-aggregation was used to synthesize findings.Findings: Seven 'synthesized findings' [SF] were produced: Interactions with some professionals provide active participation, choice, confidence and autonomy [SF1]; Interactions with some professionals are disempowering and depersonalized [SF2]; Effective communication, specialist knowledge and an individualized approach to information provision is needed [SF3]; Indicators of success vary and may not be clear [SF4]; Informal support from family/friends is valued [SF5]; Opportunities for peer support/social interaction is valued [SF6]; Coordination required to ensure continuity during transition to community [SF7].Conclusion: Patient reported experiences identified common factors associated with process quality (respect, choice, autonomy, information provision, communication) and activities of patient centered care (personalized care, shared decision-making, self-management support) despite heterogeneity of neurological conditions, service configurations, and geographical location. These factors impact quality of life.Implications for RehabilitationPatient reported experiences provide useful information about courtesy, respect, choice, autonomy, information provision, and communication.Outcomes of self-efficacy and self-management are important for people with stable and progressive long-term neurological conditions.Interactions with individual professionals influence engagement, self-efficacy, and self-management for people with long-term neurological conditions.Training for health and social care professionals should develop the advanced communication skills and behavior required to facilitate self-efficacy and self-management.
Collapse
Affiliation(s)
- Katherine Jackson
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Sharon Hamilton
- School of Health and Social Care, Teesside University, Middlesbrough, UK.,Teesside Centre for Evidence Informed Practice: A Joanna Briggs Institute Centre of Excellence, Teesside University, Middlesbrough, UK
| | - Susan Jones
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Steven Barr
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| |
Collapse
|
32
|
Fritz NE, Rao AK, Kegelmeyer D, Kloos A, Busse M, Hartel L, Carrier J, Quinn L. Physical Therapy and Exercise Interventions in Huntington's Disease: A Mixed Methods Systematic Review. J Huntingtons Dis 2018; 6:217-235. [PMID: 28968244 PMCID: PMC5676854 DOI: 10.3233/jhd-170260] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background: A number of studies evaluating physical therapy and exercise interventions in Huntington’s disease have been conducted over the past 15 years. However, an assessment of the quality and strength of the evidence in support of these interventions is lacking. Objective: The purpose of this systematic review was to investigate the effectiveness of physical therapy and exercise interventions in people with Huntington’s disease, and to examine the perceptions of patients, families and caregivers of these interventions. Methods: This mixed-methods systematic review utilized the Joanna Briggs Institute (JBI) approach and extraction tools to evaluate the literature from January 2003 until May 2016. The review considered interventions that included exercise and physical therapy interventions, and included both quantitative and qualitative outcome measures. Results: Twenty (20) studies met the inclusion criteria, including eighteen (18) that had quantitative outcome measures and two (2) that utilized qualitative methods. JBI Levels of evidence for the 18 quantitative studies were as follows: Eight studies were at evidence Level 1, seven were at Level 2, two were at Level 3, and one was at Level 4. Conclusions: Our review suggests that there is preliminary support for the benefits of exercise and physical activity in Huntington’s disease in terms of motor function, gait speed, and balance, as well as a range of physical and social benefits identified through patient-reported outcomes. Variability in mode of intervention as well as outcome measures limits the interpretability of these studies, and high-quality studies that incorporate adaptive trial designs for this rare disease are needed.
Collapse
Affiliation(s)
- Nora E Fritz
- Program in Physical Therapy, Wayne State University, Detroit, MI, USA
| | - Ashwini K Rao
- Program in Physical Therapy, Department of Rehabilitative and Regenerative Medicine, Columbia University, New York, NY, USA
| | - Deb Kegelmeyer
- Physical Therapy Division, School of Health and Rehabilitation Sciences, Ohio State University, Columbus, USA
| | - Anne Kloos
- Physical Therapy Division, School of Health and Rehabilitation Sciences, Ohio State University, Columbus, USA
| | - Monica Busse
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Lynda Hartel
- Health Sciences Library, The Ohio State University, Columbus, OH, USA
| | - Judith Carrier
- The Wales Centre for Evidence-Based Care, a Joanna Briggs Institute Centre of Excellence, School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Lori Quinn
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| |
Collapse
|
33
|
Carlozzi NE, Ready RE, Frank S, Cella D, Hahn EA, Goodnight SM, Schilling SG, Boileau NR, Dayalu P. Patient-reported outcomes in Huntington's disease: Quality of life in neurological disorders (Neuro-QoL) and Huntington's disease health-related quality of life (HDQLIFE) physical function measures. Mov Disord 2017; 32:1096-1102. [PMID: 28556412 PMCID: PMC5605785 DOI: 10.1002/mds.27046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 04/17/2017] [Accepted: 04/19/2017] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND There is a need for patient-reported outcome measures that capture the impact that motor impairments have on health-related quality of life in individuals with Huntington's disease. OBJECTIVES The objectives of this study were to establish the reliability and validity of new physical functioning patient-reported outcome measures in Huntington's disease. METHODS A total of 510 individuals with Huntington's disease completed 2 Quality of Life in Neurological Disorders (Lower Extremity Function and Upper Extremity Function) and 3 Huntington's Disease Health-Related Quality of Life (Chorea, Speech Difficulties, and Swallowing Difficulties) measures. Clinician-rated and generic self-report measures were also administered. RESULTS Reliabilities for the new patient reported physical functioning measures were excellent (all Cronbach's α > .92). Convergent, discriminant validity and known group validity was supported. CONCLUSIONS The results provide psychometric support for new patient-reported physical functioning measures and the fact that these measures can be used as clinically meaningful endpoints in Huntington's disease research and clinical practice. © 2017 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Rebecca E Ready
- Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, Massachusetts, USA
| | - Samuel Frank
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - David Cella
- Institute for Health Services Research & Policy Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois, USA
| | - Elizabeth A Hahn
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois, USA
| | - Siera M Goodnight
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Stephen G Schilling
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicholas R Boileau
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Praveen Dayalu
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
34
|
Quinn L, Morgan D. From Disease to Health: Physical Therapy Health Promotion Practices for Secondary Prevention in Adult and Pediatric Neurologic Populations. J Neurol Phys Ther 2017; 41 Suppl 3:S46-S54. [PMID: 28628596 PMCID: PMC5477649 DOI: 10.1097/npt.0000000000000166] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE Over the last decade there has been a substantial increase in efforts to better understand how targeted physical activity and exercise interventions can be used to minimize secondary consequences arising from neurological damage in both adult and pediatric populations. This article offers an overview of contemporary research that addresses mediators of functional and neuroplastic adaptations associated with physical activity and exercise. We emphasize the important role that physical therapists can play to increase participation and improve well-being in adults and children with neurological disorders. We further highlight potential strategies to foster translation of evidence-based findings for use by clinicians and consumers. SUMMARY OF KEY POINTS Engagement in physical activity can serve as a powerful promoter of health and well-being in adults and youth with neurologic disease, and has the potential to alter the course of disease processes. Physical therapists can play a key role in promoting fitness and wellness by encouraging active living, providing early diagnosis of disease and prescribing targeted activity interventions to improve fitness and participation, and helping individuals overcome personal and environmental barriers to an active lifestyle. RECOMMENDATIONS FOR CLINICAL PRACTICE Physical therapists must adopt a model of rehabilitation that emphasizes secondary prevention in adults and youth with neurologic diseases. Physical therapists have a unique role in developing forward-thinking approaches in using innovative health and wellness strategies to promote positive changes in activity and exercise behaviors.
Collapse
Affiliation(s)
- Lori Quinn
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York (L.Q.); and Department of Health and Human Performance, Middle Tennessee State University, Murfreesboro (D.M.)
| | | |
Collapse
|
35
|
Abstract
Over the last decade, neural transplantation has emerged as one of the more promising, albeit highly experimental, potential therapeutics in neurodegenerative disease. Preclinical studies in rat lesion models of Huntington's disease (HD) and Parkinson's disease (PD) have shown that transplanted precursor neuronal tissue from a fetus into the lesioned striatum can survive, integrate, and reconnect circuitry. Importantly, specific training on behavioral tasks that target striatal function is required to encourage functional integration of the graft to the host tissue. Indeed, "learning to use the graft" is a concept recently adopted in preclinical studies to account for unpredicted profiles of recovery posttransplantation and is an emerging strategy for improving graft functionality. Clinical transplant studies in HD and PD have resulted in mixed outcomes. Small sample sizes and nonstandardized experimental procedures from trial to trial may explain some of this variability. However, it is becoming increasingly apparent that simply replacing the lost neurons may not be sufficient to ensure the optimal graft effects. The knowledge gained from preclinical grafting and training studies suggests that lifestyle factors, including physical activity and specific cognitive and/or motor training, may be required to drive the functional integration of grafted cells and to facilitate the development of compensatory neural networks. The clear implications of preclinical studies are that physical activity and cognitive training strategies are likely to be crucial components of clinical cell replacement therapies in the future. In this chapter, we evaluate the role of general activity in mediating the physical ability of cells to survive, sprout, and extend processes following transplantation in the adult mammalian brain, and we consider the impact of general and specific activity at the behavioral level on functional integration at the cellular and physiological level. We then highlight specific research questions related to timing, intensity, and specificity of training in preclinical models and synthesize the current state of knowledge in clinical populations to inform the development of a strategy for neural transplantation rehabilitation training.
Collapse
|
36
|
Khalil H, Busse M, Quinn L, Nazzal M, Batyha W, Alkhazaleh S, Alomari MA. A pilot study of a minimally supervised home exercise and walking program for people with Parkinson's disease in Jordan. Neurodegener Dis Manag 2017; 7:73-84. [DOI: 10.2217/nmt-2016-0041] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Aim: This study aimed to evaluate the feasibility and cultural considerations of a minimally supervised, home-based exercise program in Jordan. Methods: Quantitative and qualitative approaches were used. Thirty participants were randomly allocated to either an 8-week intervention group (n = 16), or a standard care group (n = 14). The intervention incorporated the home use of an exercise DVD, walking program and initial instructional sessions and weekly phone calls provided by a physiotherapist. Interviews were used to explore feasibility. Unified Parkinson's disease rating scale (UPDRS-III); balance and walking speed were assessed. Results: The retention rate was 86.7% and mean adherence rate was 77%. Personal and sociocultural barriers of adherence to the exercise program were identified. UPDRS-III at follow-up was lower in the intervention group. Conclusion: A home exercise program was feasible. Sociocultural barriers specific to Arabic culture may affect the uptake of such an intervention in Parkinson's disease in these countries.
Collapse
Affiliation(s)
- Hanan Khalil
- Faculty of Applied Medical Sciences, Department of Rehabilitation Sciences, Jordan University of Science & Technology, Irbid, Jordan
| | - Monica Busse
- Cardiff University, Centre for Trials Research, Cardiff, UK
| | - Lori Quinn
- Teachers College, Columbia University, Department of Biobehavioral Sciences, New York, NY, USA
| | - Mohammad Nazzal
- Faculty of Applied Medical Sciences, Department of Rehabilitation Sciences, Jordan University of Science & Technology, Irbid, Jordan
| | - Waleed Batyha
- Neurology Department, Princess Basma Hospital, Irbid, Jordan
| | - Shatha Alkhazaleh
- Faculty of Applied Medical Sciences, Department of Rehabilitation Sciences, Jordan University of Science & Technology, Irbid, Jordan
| | - Mahmoud A Alomari
- Division of Physical Therapy, Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan
| |
Collapse
|
37
|
Development and Delivery of a Physical Activity Intervention for People With Huntington Disease: Facilitating Translation to Clinical Practice. J Neurol Phys Ther 2017; 40:71-80. [PMID: 26863152 PMCID: PMC4795097 DOI: 10.1097/npt.0000000000000119] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Supplemental Digital Content is Available in the Text. Background and Purpose: We studied the development and delivery of a 14-week complex physical activity intervention for people with Huntington disease, where detailed information about the intervention was fully embedded in the trial design process. Methods: Intervention Development: The intervention was developed through a series of focus groups. The findings from the focus groups informed the development of a logic model for the physical activity intervention that was broadly consistent with the framework of self-determination theory. Intervention Delivery: Key components underpinning the delivery of the intervention were implemented including a defined coach training program and intervention fidelity assessment methods. Training of coaches (physical therapists, occupational therapists, research nurses, and exercise trainers) was delivered via group and 1:1 training sessions using a detailed coach's manual, and with ongoing support via video calls, and e-mail communication as needed. Detailed documentation was provided to determine costs of intervention development and coach training. Results: Intervention delivery coaches at 8 sites across the United Kingdom participated in the face-to-face training. Self-report checklists completed by each of the coaches indicated that all components of the intervention were delivered in accordance with the protocol. Mean (standard deviation) intervention fidelity scores (n = 15), as measured using a purpose-developed rating scale, was 11 (2.4) (out of 16 possible points). Coaches' perceptions of intervention fidelity were similarly high. The total cost of developing the intervention and providing training was £30,773 ($47,042 USD). Discussion and Conclusions: An important consideration in promoting translation of clinical research into practice is the ability to convey the detailed components of how the intervention was delivered to facilitate replication if the results are favorable. This report presents an illustrative example of a physical activity intervention, including the development and the training required to deliver it. This approach has the potential to facilitate reproducibility, evidence synthesis, and implementation in clinical practice. Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A122).
Collapse
|
38
|
"Pushing the Limits": Rethinking Motor and Cognitive Resources After a Highly Challenging Balance Training Program for Parkinson Disease. Phys Ther 2017; 97:81-89. [PMID: 27515945 DOI: 10.2522/ptj.20160090] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 08/01/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is growing evidence for the positive effects of exercise training programs on balance control in Parkinson disease (PD). To be effective, balance training needs to be specific, progressive, and highly challenging. Little evidence exists, however, for how people with PD-related balance impairments perceive highly challenging and progressive balance training programs with dual-task components. OBJECTIVE The purpose of this study was to explore and describe perceptions of a highly challenging balance training program among people with mild to moderate PD. DESIGN This study was qualitative in nature. In-depth interviews were conducted with 13 individuals with mild to moderate PD who had participated in a highly challenging balance training program. Interview transcripts were analyzed using qualitative content analysis, with an inductive approach. RESULTS The analysis revealed 3 subthemes concerning participants' perceptions of highly challenging and progressive balance training: (1) movement to counter the disease, (2) dual-task training in contrast to everyday strategies, and (3) the struggle to maintain positive effects. The first subtheme reflects how physical activity was used as a short-term and long-term strategy for counteracting PD symptoms and their progression. The second subtheme incorporates the described experiences of being maximally challenged in a secure and supportive group environment, circumstances that stood in contrast to participants' everyday lives. The third subtheme describes participants' long-term struggle to maintain program effects on cognitive and physical function in the face of disease progression. Interpretation of the underlying patterns of these subthemes resulted in one overarching theme: training at the limits of balance capacity causes a rethinking motor and cognitive resources. LIMITATIONS The findings of this study cannot be considered to reflect the beliefs of those with weaker or negative beliefs concerning physical activity or be transferred to those at more severe stages of the disease. CONCLUSIONS Findings from this study suggest that being pushed to the limits of balance capacity provoked people with mild to moderate PD to rethink their individual motor and cognitive resources, a process that was further enabled by the PD-specific group setting.
Collapse
|
39
|
Quinn L, Busse M. The role of rehabilitation therapy in Huntington disease. HANDBOOK OF CLINICAL NEUROLOGY 2017; 144:151-165. [PMID: 28947114 DOI: 10.1016/b978-0-12-801893-4.00013-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The role of rehabilitation interventions is increasingly considered a key component to effective management of people with Huntington disease (HD). Lifestyle factors, such as activity level and exercise, as well as specific motor training may be helpful in managing the functional sequelae of HD and possibly slowing disease progression. In this chapter, we focus on the role of rehabilitation therapy in secondary and tertiary prevention of the potentially devastating consequences of HD. We provide a brief overview of the range of motor and cognitive impairments in HD and their effect on functional abilities. We further discuss emerging evidence in terms of the role of exercise, physical activity, and physical therapies in helping to minimize functional loss and maximize quality of life throughout the disease process. Future directions with respect to intensive and goal-directed exercise, including aerobic and strengthening programs, are also discussed. This is an area of particular importance alongside exploring the potential that motor-training paradigms have in mediating the effects of disease-modifying drugs, cell replacement therapy, or genetic manipulations, when available.
Collapse
Affiliation(s)
- Lori Quinn
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, United States.
| | - Monica Busse
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| |
Collapse
|
40
|
Nilsson MH, Iwarsson S, Thordardottir B, Haak M. Barriers and Facilitators for Participation in People with Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2016; 5:983-92. [PMID: 26599298 DOI: 10.3233/jpd-150631] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Activity performance is marked by the degenerative nature of Parkinson's disease (PD), but few qualitative studies have focused on how people with PD perceive participation in life situations. OBJECTIVE To identify and describe barriers and facilitators for participation from the perspective of people with PD. METHODS Qualitative data was obtained by the focus group method using a semi-structured interview guide. Participants were recruited by purposeful sampling until saturation was reached. Homogeneity within each focus group was based on self-rated PD severity (mild, moderate, severe). Nine focus groups (three per PD severity level) included a total of 29 participants. RESULTS Complex dynamics between the individual and the physical and social environment create barriers and facilitators for participation as described in the four categories which emerged out of the focus group discussions. The category Ambiguity of attitudes and the support of others describes how attitudes and support of other people act both as facilitators and barriers for participation. PD specific complexity of the body and physical environment interaction describes barriers for participation. Facilitators emerged in the two categories PD expertise in health care and social services and Information and education foster PD specific understanding. CONCLUSIONS Our findings imply several potential means to facilitate participation for people with PD, taking the person as well as the environment into account in person-centred interventions. This involves aspects such as having access to PD specific expertise, increasing the knowledge and thereby the understanding of PD as well as providing support for maintained work-life.
Collapse
|
41
|
Patients' Views on a Combined Action Observation and Motor Imagery Intervention for Parkinson's Disease. PARKINSONS DISEASE 2016; 2016:7047910. [PMID: 27777809 PMCID: PMC5061967 DOI: 10.1155/2016/7047910] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/04/2016] [Accepted: 08/16/2016] [Indexed: 11/17/2022]
Abstract
Background. Action observation and motor imagery activate neural structures involved in action execution, thereby facilitating movement and learning. Although some benefits of action observation and motor imagery have been reported in Parkinson's disease (PD), methods have been based on stroke rehabilitation and may be less suitable for PD. Moreover, previous studies have focused on either observation or imagery, yet combining these enhances effects in healthy participants. The present study explores the feasibility of a PD-specific home-based intervention combining observation, imagery, and imitation of meaningful everyday actions. Methods. A focus group was conducted with six people with mild to moderate PD and two companions, exploring topics relating to the utility and feasibility of a home-based observation and imagery intervention. Results. Five themes were identified. Participants reported their experiences of exercise and use of action observation and motor imagery in everyday activities, and the need for strategies to improve movement was expressed. Motivational factors including feedback, challenge, and social support were identified as key issues. The importance of offering a broad range of actions and flexible training was also highlighted. Conclusions. A home-based intervention utilising action observation and motor imagery would be useful and feasible in mild to moderate PD.
Collapse
|
42
|
Peek K, Carey M, Sanson-Fisher R, Mackenzie L. Physiotherapists’ perceptions of patient adherence to prescribed self-management strategies: a cross-sectional survey of Australian physiotherapists. Disabil Rehabil 2016; 39:1932-1938. [DOI: 10.1080/09638288.2016.1212281] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Kerry Peek
- Health Behaviour Research Group, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Mariko Carey
- Health Behaviour Research Group, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Robert Sanson-Fisher
- Health Behaviour Research Group, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Lisa Mackenzie
- Health Behaviour Research Group, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW, Australia
| |
Collapse
|
43
|
Rafferty MR, Corcos DM. Commentary on "A Tandem Cycling Program: Feasibility and Physical Performance Outcomes in People With Parkinson Disease". J Neurol Phys Ther 2016; 40:230-1. [PMID: 27548749 DOI: 10.1097/npt.0000000000000144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
44
|
Quinn L, Hamana K, Kelson M, Dawes H, Collett J, Townson J, Roos R, van der Plas AA, Reilmann R, Frich JC, Rickards H, Rosser A, Busse M. A randomized, controlled trial of a multi-modal exercise intervention in Huntington's disease. Parkinsonism Relat Disord 2016; 31:46-52. [PMID: 27423921 DOI: 10.1016/j.parkreldis.2016.06.023] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 05/13/2016] [Accepted: 06/30/2016] [Indexed: 01/21/2023]
Abstract
INTRODUCTION This study aimed to evaluate the feasibility and benefit of a structured exercise intervention in people with Huntington's Disease (HD). METHODS This study was conducted at 6 sites, and participants were randomized into either exercise or control (usual care) groups, and were assessed at baseline, 13 and 26 weeks. The intervention was a 12 week, three times per week progressive exercise program, including aerobic (stationary cycling) and upper and lower body strengthening exercise with tapered 1:1 support for 20 of 36 sessions. RESULTS 314 adults were assessed for eligibility: 248 did not meet inclusion criteria, 34 declined, and 32 were recruited and randomized. Three individuals in the intervention group were withdrawn within the first month due to concomitant medical conditions, resulting in 14 participants in intervention and 15 in control groups. There were two AEs in the intervention group, both related to previous medical conditions, and there were two SAEs, both in the control group. The intervention group had better fitness (predicted VO2 max difference: 492.3 ml min-1, 95% CI: [97.1, 887.6]), lower UHDRS mMS (difference 2.9 points, 95% [-5.42, -0.32]) and lower weight at Week 13 (difference 2.25 kg, 95% CI: [-4.47, -0.03]). CONCLUSION This study demonstrates that a short-term exercise intervention is safe and feasible. Individuals with HD may benefit from structured exercise, and intensity, monitoring and support may be key factors in optimizing response. Larger scale trials are now required to fully elucidate the extended clinical potential of exercise in HD. TRIAL REGISTRATION Current Controlled Trials ISRCTN11392629.
Collapse
Affiliation(s)
- Lori Quinn
- School of Healthcare Sciences, Cardiff University, UK; Department of Biobehavioral Sciences, Teachers College, Columbia University, USA.
| | - Katy Hamana
- School of Healthcare Sciences, Cardiff University, UK
| | - Mark Kelson
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, UK
| | - Helen Dawes
- Oxford Institute of Nursing and Allied Health Research Oxford Brookes University, UK
| | - Johnny Collett
- Oxford Institute of Nursing and Allied Health Research Oxford Brookes University, UK
| | - Julia Townson
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, UK
| | - Raymund Roos
- Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands
| | | | - Ralf Reilmann
- George-Huntington-Institute, Münster, Germany; Dept. of Radiology, University of Münster, Münster, Germany; Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tuebingen, Germany
| | - Jan C Frich
- Vikersund Rehabilitation Centre, Vikersund, Norway; Faculty of Medicine, University of Oslo, Norway
| | - Hugh Rickards
- Institute of Clinical Sciences, University of Birmingham, UK
| | - Anne Rosser
- Cardiff Brain Repair Group, Neuroscience and Mental Health Institute, MRC Centre for Neuropsychiatric Genetics and Genomics, Schools of Medicine and Biosciences, Cardiff University, Cardiff, CF10 3BB, UK
| | - Monica Busse
- School of Healthcare Sciences, Cardiff University, UK; South East Wales Trials Unit, Centre for Trials Research, Cardiff University, UK
| |
Collapse
|
45
|
Clark D, Danzl MM, Ulanowski E. Development of a community-based exercise program for people diagnosed and at-risk for Huntington's disease: A clinical report. Physiother Theory Pract 2016; 32:232-9. [PMID: 27046737 DOI: 10.3109/09593985.2015.1110738] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Given the neurodegenerative nature of Huntington's disease (HD), community-based exercise programs that meet the ongoing needs of those living with HD are needed. The genetic nature of HD warrants the inclusion of those at-risk for HD. The purpose of this clinical report is to describe an evidence-based approach to the design of a community-based exercise program to improve gait, balance, and fatigue for individuals diagnosed with and at-risk for HD. PROGRAM DESIGN Based on the literature, clinical expertise and patient values, the program was designed to include four key features: (1) community-based group format for individuals with HD, caregivers, and those at-risk for HD; (2) individualized prescription within the group; (3) circuit training; and (4) use of outcome measures. PROGRAM IMPLEMENTATION AND OUTCOMES: The group met once weekly for 8 weeks for balance, strength, and cardiovascular fitness exercises. Three individuals participated, two diagnosed with HD and 1 considered "at-risk" for HD. Pre- and post- outcome measures included the 10 meter walk test, Berg Balance Scale, Fatigue Impact Scale, and the Timed Up and Go. Participants demonstrated improvement or maintenance of abilities in all measures with no adverse events. DISCUSSION This clinical report describes the integration of the evidence, clinical expertise, and patient values to develop and implement individualized, community-based exercise groups, aimed to improve balance, gait speed, and fatigue measures for persons with HD and those at-risk. Post-program reflections and recommendations for those who are interested in developing similar programs in other communities are described.
Collapse
Affiliation(s)
- Dalie Clark
- a Neuroresident and Adjunct Faculty , Bellarmine University , Louisville , KY , USA
| | - Megan M Danzl
- b Physical Therapy Program, Bellarmine University , Louisville , KY , USA
| | - Elizabeth Ulanowski
- b Physical Therapy Program, Bellarmine University , Louisville , KY , USA.,c Norton Healthcare , Louisville , KY , USA
| |
Collapse
|
46
|
Acute and Chronic Effect of Acoustic and Visual Cues on Gait Training in Parkinson's Disease: A Randomized, Controlled Study. PARKINSONS DISEASE 2015; 2015:978590. [PMID: 26693384 PMCID: PMC4674608 DOI: 10.1155/2015/978590] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 10/17/2015] [Accepted: 11/10/2015] [Indexed: 11/29/2022]
Abstract
In this randomized controlled study we analyse and compare the acute and chronic effects of visual and acoustic cues on gait performance in Parkinson's Disease (PD). We enrolled 46 patients with idiopathic PD who were assigned to 3 different modalities of gait training: (1) use of acoustic cues, (2) use of visual cues, or (3) overground training without cues. All patients were tested with kinematic analysis of gait at baseline (T0), at the end of the 4-week rehabilitation programme (T1), and 3 months later (T2). Regarding the acute effect, acoustic cues increased stride length and stride duration, while visual cues reduced the number of strides and normalized the stride/stance distribution but also reduced gait speed. As regards the chronic effect of cues, we recorded an improvement in some gait parameters in all 3 groups of patients: all 3 types of training improved gait speed; visual cues also normalized the stance/swing ratio, acoustic cues reduced the number of strides and increased stride length, and overground training improved stride length. The changes were not retained at T2 in any of the experimental groups. Our findings support and characterize the usefulness of cueing strategies in the rehabilitation of gait in PD.
Collapse
|
47
|
King LA, Wilhelm J, Chen Y, Blehm R, Nutt J, Chen Z, Serdar A, Horak FB. Effects of Group, Individual, and Home Exercise in Persons With Parkinson Disease: A Randomized Clinical Trial. J Neurol Phys Ther 2015; 39:204-12. [PMID: 26308937 PMCID: PMC4772717 DOI: 10.1097/npt.0000000000000101] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE Comparative studies of exercise interventions for people with Parkinson disease (PD) rarely considered how one should deliver the intervention. The objective of this study was to compare the success of exercise when administered by (1) home exercise program, (2) individualized physical therapy, or (3) a group class. We examined if common comorbidities associated with PD impacted success of each intervention. METHODS Fifty-eight people (age = 63.9 ± 8 years) with PD participated. People were randomized into (1) home exercise program, (2) individual physical therapy, or (3) group class intervention. All arms were standardized and based on the Agility Boot Camp exercise program for PD, 3 times per week for 4 weeks. The primary outcome measure was the 7-item Physical Performance Test. Other measures of balance, gait, mobility, quality of life, balance confidence, depressions, apathy, self-efficacy and UPDRS-Motor, and activity of daily living scores were included. RESULTS Only the individual group significantly improved in the Physical Performance Test. The individual exercise showed the most improvements in functional and balance measures, whereas the group class showed the most improvements in gait. The home exercise program improved the least across all outcomes. Several factors effected success, particularly for the home group. DISCUSSION AND CONCLUSIONS An unsupervised, home exercise program is the least effective way to deliver exercise to people with PD, and individual and group exercises have differing benefits. Furthermore, people with PD who also have other comorbidities did better in a program directly supervised by a physical therapist.Video Abstract available for additional insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A112).
Collapse
Affiliation(s)
- Laurie A King
- Department of Neurology (L.A.K., R.B., J.N., F.B.H.), Department of Rehabilitation Services (J.W., A.S.), and Department of Public Health and Preventive Medicine (Y.C., Z.C.), Oregon Health & Science University, Portland, Oregon
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Khalil H, Bajwa JA. Barriers and Facilitators in Physical Rehabilitation for Parkinson's Disease in the Arabian World. Mov Disord Clin Pract 2015; 2:227-229. [PMID: 30363552 PMCID: PMC6178601 DOI: 10.1002/mdc3.12200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 04/25/2015] [Accepted: 04/27/2015] [Indexed: 11/06/2022] Open
Affiliation(s)
- Hanan Khalil
- Department of Rehabilitations SciencesFaculty of Applied Medical SciencesJordan University of Science and TechnologyIrbidJordan
| | - Jawad A. Bajwa
- King Saud Bin AbdulAziz University for Health SciencesRiyadhSaudi Arabia
- Parkinson's, Movement Disorders and NeurorestorationDepartment of NeurologyNational Neuroscience InstituteKing Fahad Medical CityRiyadhSaudi Arabia
| |
Collapse
|
49
|
O’Brien C, Clemson L, Canning CG. Multiple factors, including non-motor impairments, influence decision making with regard to exercise participation in Parkinson’s disease: a qualitative enquiry. Disabil Rehabil 2015; 38:472-81. [DOI: 10.3109/09638288.2015.1055377] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
50
|
Blandy LM, Beevers WA, Fitzmaurice K, Morris ME. Therapeutic Argentine Tango Dancing for People with Mild Parkinson's Disease: A Feasibility Study. Front Neurol 2015; 6:122. [PMID: 26074873 PMCID: PMC4445309 DOI: 10.3389/fneur.2015.00122] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 05/12/2015] [Indexed: 11/18/2022] Open
Abstract
Background Individuals living with Parkinson’s disease (PD) can experience a range of movement disorders that affect mobility and balance and increase the risk of falls. Low health-related quality of life, depression, and anxiety are more common in people with PD than age-matched comparisons. Therapeutic dance is a form of physical activity believed to facilitate movement and therapy uptake. As well as being enjoyable, dancing is thought to improve mobility, balance, and well-being in some people living with PD. The primary objective of this study was to evaluate the feasibility and safety of a 4-week Argentine tango dance program for people with PD. Methods Six community dwelling individuals with mild to moderate PD were recruited from Parkinson’s support groups, movement disorder clinics, and the PD association in Australia. To minimize falls risk, participants were required to be <75 years of age and physically independent (Hoehn and Yahr stages I–III). They were also required to speak English. Participants attended a 1-hour dance class at a dance studio twice per week for 4 weeks. A professional dance instructor led and choreographed the Argentine tango dance classes. Physiotherapists were present to assist participants during the class and served as dance partners as necessary. The primary outcome was feasibility, which was determined by measures of recruitment, adherence, attrition, safety (falls, near misses and adverse events), and resource requirements. Secondary measures included the Beck Depression Inventory and the Euroqol-5D, administered at baseline and post intervention. Therapy outcomes pre- and post-intervention were analyzed descriptively as medians and interquartile ranges and using Wilcoxon matched pair signed-rank tests. Results The Argentine tango dance intervention was shown to be safe, with no adverse events. Adherence to the dance program was 89%. Depression scores improved after intervention (p = 0.04). Some challenges were associated with the need to quickly recruit participants and physiotherapists to act as dance partners during classes and to monitor participants. Conclusion The 4-week, twice weekly Argentine tango dancing program was shown to be feasible and safe for people with mild-to-moderately severe PD.
Collapse
Affiliation(s)
- Laura M Blandy
- College of Science, Health and Engineering, School of Allied Health, La Trobe University , Bundoora, VIC , Australia
| | - Winifred A Beevers
- College of Science, Health and Engineering, School of Allied Health, La Trobe University , Bundoora, VIC , Australia
| | - Kerry Fitzmaurice
- College of Science, Health and Engineering, School of Allied Health, La Trobe University , Bundoora, VIC , Australia
| | - Meg E Morris
- College of Science, Health and Engineering, School of Allied Health, La Trobe University , Bundoora, VIC , Australia
| |
Collapse
|