Occupational therapy for Parkinson's disease
Abstract
Background
Despite drug and surgical therapies for Parkinson's disease, patients develop progressive disability. The role of the occupational therapist is to support the patient and help them maintain their usual level of self‐care, work and leisure activities for as long as possible. When it is no longer possible to maintain their usual activities, occupational therapists support individuals in changing and adapting their relationship with their physical and social environment to develop new valued activities and roles.
Objectives
To compare the efficacy and effectiveness of occupational therapy with placebo or no interventions (control group) in patients with Parkinson's disease.
Search methods
Relevant trials were identified by electronic searches of MEDLINE, EMBASE, CINAHL, ISI‐SCI, AMED, MANTIS, REHABDATA, REHADAT, GEROLIT, Pascal, LILACS, MedCarib, JICST‐EPlus, AIM, IMEMR, SIGLE, ISI‐ISTP, DISSABS, Conference Papers Index, Aslib Index to Theses, the Cochrane Controlled Trials Register, the CentreWatch Clinical Trials listing service, the metaRegister of Controlled Trials, ClinicalTrials.gov, CRISP, PEDro, NIDRR and NRR; and the reference lists of identified studies and other reviews were examined.
Selection criteria
Only randomised controlled trials (RCT) were included, however those trials that allowed quasi‐random methods of allocation were allowed.
Data collection and analysis
Data was abstracted independently by two authors and differences were settled by discussion.
Main results
Two trials were identified with 84 patients in total. Although both trials reported a positive effect from occupational therapy, all of the improvements were small. The trials did not have adequate placebo treatments, used small numbers of patients and the method of randomisation and concealment of allocation was not specified in one trial. These methodological problems could potentially lead to bias from a number of sources reducing the strength of the studies further.
Authors' conclusions
Considering the significant methodological flaws in the studies, the small number of patients examined, and the possibility of publication bias, there is insufficient evidence to support or refute the efficacy of occupational therapy in Parkinson's disease. There does not appear to be a consensus as to the best practice in occupational therapy when treating people with Parkinson's disease. A survey of therapists is needed to determine what methods of occupational therapy are currently being used by therapists to treat Parkinson's disease, and whether there is a consensus as to 'best‐practice'. Large well designed placebo‐controlled RCTs are needed to demonstrate occupational therapy's effectiveness in Parkinson's disease. Outcome measures with particular relevance to patients, carers, occupational therapists and physicians should be chosen and the patients monitored for at least six months to determine the duration of benefit. The trials should be reported using CONSORT guidelines.
Plain language summary
Parkinson's disease is a progressive disabling neurodegenerative disease. The role of the occupational therapist is to support individuals with Parkinson's disease and to enable them to maintain their usual level of self‐care, work and leisure activities for as long as possible.
This review will compare the benefits of occupational therapy versus placebo (sham treatment) or no treatment for individuals with Parkinson's disease. Relevant trials were identified by electronic searches of 21 medical literature databases, various registers of clinical trials and an examination of the reference lists of the identified studies and other reviews.
Only randomised controlled trials were included in this review. These were studies where two groups of patients were compared, one group of patients had occupational therapy, the other was given no or sham treatment. The patients were assigned to each of the two groups in a random fashion so as to reduce the potential for bias. Data from these studies were abstracted independently by two reviewers and differences settled by discussion.
Two trials were found comparing occupational therapy with placebo in a total of 84 patients. The methodological quality of the trials was variable with both the studies failing in at least one critical area. Both of the trials reported a beneficial effect of occupational therapy on patients with Parkinson's disease. However the improvements were small and it is unclear whether they would be clinically significant.
There is insufficient evidence to support or disprove the value of occupational therapy for the treatment of disability in individuals with Parkinson's disease. This is because there were methodological flaws in both of the studies, the studies examined too few patients, and there is the possibility that studies with negative results were not published (publication bias). However it should be emphasised that this lack of evidence does not mean that occupational therapy does not have an effect.
There does not appear to be a consensus as to best practice when working with people with Parkinson's disease. A survey of therapists is needed to determine what methods of occupational therapy are currently being used by therapists to treat Parkinson's disease, and whether there is a consensus as to 'best‐practice'.
Large well designed placebo‐controlled randomised controlled trials are needed to demonstrate occupational therapy's effectiveness in Parkinson's disease. The design of the trials should minimise bias and be reported fully (according to CONSORT guidelines). Outcome measures with particular relevance to patients, their carers, occupational therapists and physicians should be chosen and the patients followed for at least 6 months to determine the duration of any improvement.
