Changes in Functional Performance in Individuals With Parkinson's Disease Following 2-month Physiotherapy Intervention

Study Overview
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Brief Summary
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Aim of current study was to evaluate the effect of a 2-month comprehensive physiotherapy intervention on different aspects of functional performance. In addition, progression of PD motor symptoms (using standardized clinical tests for the assesment) was of interest

Detailed Description
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The aim of current study was to enroll 50 patients with Parkinson's disease (PD) and randomly assign them into intervention and control group. Patients were randomly contacted through the epidemiological database of patients with Parkinson' disease of South-Estonia. 44 participants agreed to come to the baseline assessment including: Timed-Up-And-Go Test Battery Four square step test Physical performance test Short Physical Performance 10-m walk test Grooved Purdue Pegboard test Assessment of range of motion In addition, current disease status was assessed using Unified Parkinson Disease Rating Scale, Mini Mental Sate Examination. Further, quality of life was assessed using PDQ-39, hand-writing was recorded using white, squared and striped paper and freezing of gait questionaire (FOG-Q) was administered. Within a week from baseline assessment participants randomly assigned to intervention group, started physiotherapy intervention. The intervention was carried out in small groups (3 people in a group) and was carried out as out-patient physiotherapy during 8 week period. During each week 2 sessions with a length of an hour were scheduled. Within a week of the last therapy session, second assessment was conducted (for control group the second assessment was carried out ten weeks post-baseline assessment. Third assessment was assigned one year after (then the same assessment was performed, in addition body composition was analysed using DXA), forth assessment an other year later. During forth assessment 15 members starting in the intervention group and 10 starting in the control group participated.

Official Title
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Functional Performance in Individuals With Parkinson's Disease: Changes Following 2-month Physiotherapy Intervention in Small Groups and Impact of Disease Progression

Conditions
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Parkinson Disease

Intervention / Treatment
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* Other: Comprehensive physical therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: confirmed diagnosis of idiopathic Parkinson Disease age within the age limits no other untreated medical conditions that might affect gait or postural stability able to walk without assistive device score of Mini Mental State Examination above 24 no other neurological conditions in medical anamnesis Exclusion Criteria: Not meeting the inclusion criteria

Ages Eligible for Study
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Minimum Age: 60 Years
Maximum Age: 81 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention group<br>Comprehensive physical therapy intervention in small groups (3 members), altogether 16 sessions were performed during a period of 8 weeks (twice a week). Each session lasted 1 hour. | Other: Comprehensive physical therapy<br>* Each session included exercises for posture, strength, range of motion, balance. In addition, different transfers and gait training was performed. Each session began with exercises in laying position (15 minutes), thereafter exercises in sitting were performed for 10 minutes. Then different exercises in standing position were performed for 15 minutes, followed by 10 minutes of gait training. 10 minutes of exercises for manual dexterity and upper limb function ended the session.<br>|
| No Intervention: Control group<br>Control group members did not receive any specific intervention during study period, but if needed, medical treatment (medication, it's dosage etc) of Parkinson Disease was changed during study period. They were assigned to individual therapy after the study period. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Gait speed during transitioning from sitting to walking and its change as a result of physiotherapy and change over time | Gait speed was calculated based an the performance of Timed up and Go test | it was assessed during all the assessments: at baseline, during second assessment ten weeks later, third assessment was carried out one year later, forth assessment was conducted another year later | 
| Gait speed during transitioning from standing to walking and its change as a result of physiotherapy and change over time | Gait speed was calculated based an the performance of Short Physical Performance Battery gait test | it was assessed during all the assessments: at baseline, during second assessment ten weeks later, third assessment was carried out one year later, forth assessment was conducted another year later | 
| Pure gait speed and its change as a result of physiotherapy and change over time | Gait speed was calculated based an the performance of 10 m walk test, with excluding the acceleration and deceleration phase (duration of the intermediate 6-meters was measured and based on that gait speed was calculated | it was assessed during all the assessments: at baseline, during second assessment ten weeks later, third assessment was carried out one year later, forth assessment was conducted another year later | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| body composition (and changes in it in one year period) | it was assessed with DXA methodology | was assessed twice (during third and fourth assessment), with a timeperiod of one year in between | 
| Timed-up-and-go test: its change as a result of physiotherapy and change over time | The duration of Timed up and go test, executed with a turn over both shoulders was used | it was assessed during all the assessments: at baseline, during second assessment ten weeks later, third assessment was carried out one year later, forth assessment was conducted another year later | 
| Four square step test: its change as a result of physiotherapy and change over time | The duration of Four square step test,was used | it was assessed during all the assessments: at baseline, during second assessment ten weeks later, third assessment was carried out one year later, forth assessment was conducted another year later | 
| Tinetti test: its change as a result of physiotherapy and change over time | The Tinetti test was executed and the score was used | it was assessed during all the assessments: at baseline, during second assessment ten weeks later, third assessment was carried out one year later, forth assessment was conducted another year later | 
| Range of motion: its change as a result of physiotherapy and change over time | Range of motion of major joints (shoulder, hip, knee, ankle) were measured goniometrically. Spinal ROM (including neck) was measured with tapemeasure, aswell as the excursion of the ribcage during maximal inspiration and expiration | it was assessed during three assessments: at baseline, during second assessment ten weeks later, third assessment was carried out one year later | 
| Assessment of handwriting:its change as a result of physiotherapy and change over time | To assess the impact of visual cues on handwriting, patients were instructed to write one simple and one complex sentence on white, striped and squared paper. During assessment, the speed of writing was registered. | it was assessed during three assessments: at baseline, during second assessment ten weeks later, third assessment was carried out one year later | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Parkinson Disease, Gait, Physical therapy, functional performance, group therapy