Self-management rehabilitation and health-related quality of life in Parkinson's disease: a randomized controlled trial

Abstract

The purpose of this randomized controlled trial was to determine whether increasing hours of self-management rehabilitation had increasing benefits for health-related quality of life (HRQOL) in Parkinson's disease beyond best medical treatment, whether effects persisted at 2 and 6 months of follow-up, and whether targeted compared with nontargeted HRQOL domains responded more to rehabilitation. Participants on best medication therapy were randomly assigned to one of three conditions for 6 weeks intervention: 0 hours of rehabilitation; 18 hours of clinic group rehabilitation plus 9 hours of attention control social sessions; and 27 hours of rehabilitation, with 18 in clinic group rehabilitation and 9 hours of rehabilitation designed to transfer clinic training into home and community routines. Results (N = 116) showed that at 6 weeks, there was a beneficial effect of increased rehabilitation hours on HRQOL measured with the Parkinson's Disease Questionnaire-39 summary index (F(1,112) = 6.48, eta = 0.23, CI = 0.05-0.40, P = 0.01). Benefits persisted at follow-up. The difference between 18 and 27 hours was not significant. Clinically relevant improvement occurred at a greater rate for 18 and 27 hours (54% improved) than for 0 hours (18% improved), a significant 36% difference in rates (95% CI = 20-52% difference). Effects were largest in two targeted domains: communication and mobility. More concerns with mobility and activities of daily living at baseline predicted more benefit from rehabilitation.

Figure 1. Flow diagram of participants through each stage of the trial

Figure 2. Adjusted means (standard error) of PDQ-39 Summary Index post intervention and at follow-up

Lower points indicate better outcomes. Values are adjusted for baseline summary index (M = 31.7, SE = 1.03).

Figure 3. HQROL responses of participants with low baseline versus high baseline scores

High baseline group had scores above the median (more problematic HQROL), while the low baseline group had scores below the median (less problematic HQROL). The bars show the raw means with error lines (SEM) comparing baseline to post intervention for each rehabilitation intensity condition.

Figure 3. HQROL responses of participants with low baseline versus high baseline scores

High baseline group had scores above the median (more problematic HQROL), while the low baseline group had scores below the median (less problematic HQROL). The bars show the raw means with error lines (SEM) comparing baseline to post intervention for each rehabilitation intensity condition.

Figure 3. HQROL responses of participants with low baseline versus high baseline scores

High baseline group had scores above the median (more problematic HQROL), while the low baseline group had scores below the median (less problematic HQROL). The bars show the raw means with error lines (SEM) comparing baseline to post intervention for each rehabilitation intensity condition.

Figure 3. HQROL responses of participants with low baseline versus high baseline scores

High baseline group had scores above the median (more problematic HQROL), while the low baseline group had scores below the median (less problematic HQROL). The bars show the raw means with error lines (SEM) comparing baseline to post intervention for each rehabilitation intensity condition.

Figure 3. HQROL responses of participants with low baseline versus high baseline scores

High baseline group had scores above the median (more problematic HQROL), while the low baseline group had scores below the median (less problematic HQROL). The bars show the raw means with error lines (SEM) comparing baseline to post intervention for each rehabilitation intensity condition.