Occupational Therapy to Optimise Independence in Parkinson's Disease: The Designing and Recording of a Randomised Controlled Trial Intervention

By Meek, Charmaine; Morgan, Eric et al. | British Journal of Occupational Therapy, April 2010 | Go to article overview

Occupational Therapy to Optimise Independence in Parkinson's Disease: The Designing and Recording of a Randomised Controlled Trial Intervention


Meek, Charmaine, Morgan, Eric, Walker, Marion F., Furmston, Alexandra, Aragon, Ana, Birleson, Angela, Kelly, Vicky, Clarke, Carl E., Sackley, Catherine M., British Journal of Occupational Therapy


Introduction

The clinical management of Parkinson's disease (PD) consists predominantly of pharmacological therapy However, even with optimal medical treatment in place, disability can still persist and progress (Deane et al 2001). In particular, PD has a profound impact on a person's ability to carry out self-care and activities of daily living (ADL) (Birleson 1998), resulting in increased dependence. For this reason, non-pharmacological treatments, such as occupational therapy, are often employed as an adjunct to traditional medical management (Deane and Playford 2003).

The inclusion of occupational therapy in the management of PD is supported by anecdotal evidence from patients and health care professionals (Deane et al 2002) and national guidelines (National Collaborating Centre for Chronic Conditions 2006). Despite this, supportive trial evidence is fairly limited, with a systematic review by Deane et al (2001) uncovering only two small randomised controlled trials (RCTs) and concluding that there was insufficient evidence to support or refute the efficacy of occupational therapy in PD. These authors recommended that large, methodologically sound, RCTs should be carried out. Consequently, in 2005 a phase II pragmatic RCT began to evaluate the acceptability of occupational therapy as practised in the United Kingdom (UK) and to provide data to underpin a sample size calculation for the large phase III RCT required in this area. This was the Parkinson's Disease Occupational Therapy trial (PDOT) (Clarke et al 2009).

To ensure reproducibility, the reporting of an RCT should include 'precise details of the interventions intended for each group, and how and when they were actually administered' (CONSORT statement, Item 4, Moher et al 2001, p1192). Therefore, in an attempt to fulfil this requirement, the PDOT team developed the intervention using a clear stepped approach and then adopted an intervention log to be used throughout the trial in order to capture the actual treatment delivered.

Following the recommendations of Deane (2006), this paper aims to detail the PDOT intervention through a designated intervention paper. More specifically, it aims to:

1. Provide a brief overview of the PDOT trial (Clarke et al 2009)

2. Describe the process undertaken to design the therapeutic intervention (including providing an outline of the evidence base available at the time of the trial)

3. Present the intervention log used within the PDOT trial

4. Report and discuss the information captured by the intervention log

5. Discuss the limitations of the log and the measures taken to improve the tool for the follow-on trial to PDOT, the phase III RCT PD REHAB.

Overview of the PDOT trial

PDOT was a phase II pragmatic RCT investigating an occupational therapy intervention designed to optimise functional independence in people with PD. The trial aimed to assess accrual and withdrawal rates, to ascertain the feasibility and acceptability of the intervention and outcome measures, and to inform a sample size calculation for a phase III RCT. As a pilot study, it was not powered to assess the effectiveness of the intervention delivered.

Briefly, patients with idiopathic PD (Hoehn and Yahr stages II to IV) exhibiting difficulties with ADL, who had not received occupational therapy within the previous 12 months, were recruited from neurology and older people's clinics within the West Midlands. Patients were randomised at the level of the individual and stratified by level of ADL impairment, as recorded by the Barthel ADL Index (Mahoney and Barthel 1965). Participants were randomised to receive either an individualised, community-delivered occupational therapy intervention or standard care with no intervention (this group received occupational therapy immediately following their final assessment at the end of the trial). For the purposes of this paper, only the intervention group is discussed. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Occupational Therapy to Optimise Independence in Parkinson's Disease: The Designing and Recording of a Randomised Controlled Trial Intervention
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.