Interventions Within the Scope of Occupational Therapy to Improve Activities of Daily Living, Rest, and Sleep in People With Parkinson's Disease: A Systematic Review

Association between the length of stay in rehabilitation and mortality among the adults with Parkinson's disease: 2009-2019 Korean National Health Insurance Service Databases

Background

Rehabilitation is recognized as an effective means of alleviating the symptoms of Parkinson's disease (PD) and improving the physical and cognitive functions of patients with PD. However, research often focuses on short-term outcomes such as functioning and quality of life. This study investigated the association between the length of stay in rehabilitation and mortality among patients with PD.

Methods

Using the Korean National Health Insurance Service database, we identified 636 participants diagnosed with PD who received rehabilitation. The main outcome was all-cause mortality. We used a Cox proportional hazards regression model to examine the relationship between length of stay in rehabilitation and mortality among patients with PD.

Results

The final sample comprised 374 females (58.81%) and 262 males (41.19%). A survival analysis revealed a significant association between the length of stay in rehabilitation and mortality, with a decrease in mortality of 16.1% in patients with PD who received one year of rehabilitation (hazard ratio = 0.839, 95% confidence interval = 0.788-0.895).

Conclusion

Our findings underscore the potential benefits of timely implementation of rehabilitative interventions in patients with PD and the need for comprehensive and long-term rehabilitation strategies. It also highlights the necessity of such services for patients with PD and the importance of developing patient-centered rehabilitation guidelines.

Clair KA, Toledo S, York MK, Todaro R, Yarab N, Wallock K. Delivering Multidisciplinary Rehabilitation Care in Parkinson's Disease: An International Consensus Statement

BACKGROUND

Parkinson's disease (PD) is a complex neurodegenerative disorder impacting everyday function and quality of life. Rehabilitation plays a crucial role in improving symptoms, function, and quality of life and reducing disability, particularly given the lack of disease-modifying agents and limitations of medications and surgical therapies. However, rehabilitative care is under-recognized and under-utilized in PD and often only utilized in later disease stages, despite research and guidelines demonstrating its positive effects. Currently, there is a lack of consensus regarding fundamental topics related to rehabilitative services in PD.

OBJECTIVE

The goal of the international Parkinson's Foundation Rehabilitation Medicine Task Force was to develop a consensus statement regarding the incorporation of rehabilitation in PD care.

METHODS

The Task Force, comprised of international multidisciplinary experts in PD and rehabilitation and people directly affected by PD, met virtually to discuss topics such as rehabilitative services, existing therapy guidelines and rehabilitation literature in PD, and gaps and needs. A systematic, interactive, and iterative process was used to develop consensus-based statements on core components of PD rehabilitation and discipline-specific interventions.

RESULTS

The expert-based consensus statement outlines key tenets of rehabilitative care including its multidisciplinary approach and discipline-specific guidance for occupational therapy, physical therapy, speech language pathology/therapy, and psychology/neuropsychology across all PD stages.

CONCLUSIONS

Rehabilitative interventions should be an essential component in the comprehensive treatment of PD, from diagnosis to advanced disease. Greater education and awareness of the benefits of rehabilitative services for people with PD and their care partners, and further evidence-based and scientific study are encouraged.

Specialized Allied Health Care for Parkinson's Disease: State of the Art and Future Directions

People with Parkinson's disease (PD) experience a range of progressive motor and non-motor symptoms, that negatively affect their daily functioning, social participation and quality of life. Allied health therapies have emerged as an effective treatment approach-complementary to pharmacological and neurosurgical treatments-which reduces the impact of PD in daily life. In this article, we propose criteria for what constitutes specialized allied health care for PD, and we review allied health research in PD in terms of meeting these criteria and its outcomes for monodisciplinary approaches as well as multi- or interdisciplinary allied health interventions. We focus on the three most studied allied health disciplines in PD: physical therapy, occupational therapy and speech-language therapy. Overall, the available evidence underscores the importance and potential benefits of specialized allied health care for people with PD. Our proposed criteria and recommendations for future research might help in further delineating specialized allied health care.

Occupational Therapy Practice Guidelines for People With Parkinson's Disease

IMPORTANCE

Occupational therapy practitioners address the occupational performance and participation needs of people with Parkinson's disease (PD) and their care partners.

OBJECTIVE

This Practice Guideline is informed by systematic reviews on the use of occupational therapy interventions to promote participation in occupations for people with PD and to facilitate their caregivers' participation in the caregiver role. This guideline is meant to support practitioners' clinical decision making when working with people with PD and their care partners.

METHOD

We examined and synthesized the results of four systematic reviews and integrated those results into clinical recommendations for practice.

RESULTS

Thirty-three articles from the systematic reviews served as the basis for the clinical recommendations in this Practice Guideline. Clinical recommendations are provided for interventions that have strong or moderate supporting evidence.

CONCLUSION AND RECOMMENDATIONS

Multidisciplinary, tailored, goal-oriented intervention is recommended for people with PD. Various forms of exercise can be used to improve activities of daily living and instrumental activities of daily living performance and social participation, and interventions should incorporate health behavior change techniques to support adequate physical activity levels in daily life. Mindfulness meditation and exercise can be used to support sleep, and task-oriented training can be used to improve performance of specific tasks. Occupational therapy practitioners should incorporate self-management, coaching, compensatory, cognitive-behavioral, and other approaches into multicomponent treatment plans depending on the client's needs and goals. Additional potentially appropriate intervention approaches or areas to address are discussed on the basis of existing or emerging evidence and expert opinion. What This Article Adds: This Practice Guideline provides a summary and applications of the current evidence supporting occupational therapy intervention for people with PD. It includes case examples and suggested decision-making algorithms to support practitioners in addressing client goals.

Role of Occupational Therapy in Facilitating Participation Among Caregivers of People With Parkinson's Disease: A Systematic Review

IMPORTANCE

Caregivers play a critical role in facilitating the performance of people with Parkinson's disease (PD). Knowledge on how occupational therapy practitioners can mitigate the negative effects of caregiving is needed to enable caregiver participation.

OBJECTIVE

To explore the effectiveness of interventions within the scope of occupational therapy practice for caregivers of people with PD to facilitate or maintain their participation in the caregiver role.

DATA SOURCES

We conducted a systematic review of the literature published in CINAHL, MEDLINE, PsycINFO, and OTseeker between 2011 and 2019. Article reference lists were also hand searched for additional articles. Study Selection and Data Collection: Articles were screened and evaluated using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. The review was conducted in accordance with steps outlined by the American Occupational Therapy Association's Evidence-Based Practice Project.

FINDINGS

Six articles met the inclusion criteria. Interventions in each article were distinct, prohibiting theme development. Overall, the strength of evidence was low, and the risk of bias was high. None of the studies included in this review were obtained from the occupational therapy literature.

CONCLUSIONS AND RELEVANCE

Little evidence is available to support interventions within the scope of occupational therapy practice for caregivers of people with PD. Existing evidence suggests that interventions need to be flexible (e.g., in terms of time, cost, and delivery method) and tailored to the unique needs of this population. What This Article Adds: There is a continued need to develop occupational therapy interventions that support participation in the caregiving role for caregivers of people with PD.

Occupational Therapy Interventions for Instrumental Activities of Daily Living for Adults With Parkinson's Disease: A Systematic Review

IMPORTANCE

Instrumental activities of daily living (IADLs) are important for independence, safety, and productivity, and people with Parkinson's disease (PD) can experience IADL limitations. Occupational therapy practitioners should address IADLs with their clients with PD.

OBJECTIVE

To systematically review the evidence for the effectiveness of occupational therapy interventions to improve or maintain IADL function in adults with PD.

DATA SOURCES

MEDLINE, CINAHL, PsycINFO, OTseeker, and Cochrane databases from January 2011 to December 2018. Study Selection and Data Collection: Primary inclusion criteria were peer-reviewed journal articles describing Level 1-3 studies that tested the effect of an intervention within the scope of occupational therapy on an IADL outcome in people with PD. Three reviewers assessed records for inclusion, quality, and validity following Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

FINDINGS

Twenty-two studies met the inclusion criteria and were categorized into four themes on the basis of primary focus or type of intervention: physical activity, specific IADL-focused, cognitive rehabilitation, and individualized occupational therapy interventions. There were 9 Level 1b, 9 Level 2b, and 4 Level 3b studies. Strong strength of evidence was found for the beneficial effect of occupational therapy-related interventions for physical activity levels and handwriting, moderate strength of evidence for IADL participation and medication adherence, and low strength of evidence for cognitive rehabilitation.

CONCLUSIONS AND RELEVANCE

Occupational therapy interventions can improve health management and maintenance (i.e., physical activity levels, medication management), handwriting, and IADL participation for people with PD. Further research is needed on cognitive rehabilitation. This review is limited by the small number of studies that specifically addressed IADL function in treatment and as an outcome. What This Article Adds: Occupational therapy intervention can be effective in improving or maintaining IADL performance and participation in people with PD. Occupational therapy practitioners can address IADL function through physical activity interventions, interventions targeting handwriting and medication adherence, and individualized occupational therapy interventions.