Intervention Review

Occupational therapy for patients with Parkinson's disease

  1. Lynn Dixon2,
  2. Dawn C Duncan2,
  3. Paul Johnson2,
  4. Liz Kirkby3,
  5. Helen O'Connell4,
  6. Hilary J Taylor5,
  7. Katherine Deane1,*

Editorial Group: Cochrane Movement Disorders Group

Published Online: 18 JUL 2007

Assessed as up-to-date: 19 MAY 2007

DOI: 10.1002/14651858.CD002813.pub2


How to Cite

Dixon L, Duncan DC, Johnson P, Kirkby L, O'Connell H, Taylor HJ, Deane K. Occupational therapy for patients with Parkinson's disease. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD002813. DOI: 10.1002/14651858.CD002813.pub2.

Author Information

  1. 1

    Community and Education Studies Northumbria University, School of Health, Newcastle upon Tyne, UK

  2. 2

    Gateshead Health NHS Foundation Trust, Department of Physiotherapy, Gateshead, Tyne and Wear, UK

  3. 3

    Not specified

  4. 4

    Gateshead Health NHS Foundation Trust, Gateshead, Tyne and Wear, UK

  5. 5

    Gateshead Health NHS Foundation Trust, Department of Speech and Language Therapy, Gateshead, Tyne and Wear, UK

*Katherine Deane, School of Health, Community and Education Studies Northumbria University, Coach Lane, Benton, Newcastle upon Tyne, NE7 7XA, UK. katherine.deane@northumbria.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 18 JUL 2007

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Despite drug and surgical therapies for Parkinson's disease, patients develop progressive disability. It has both motor and non-motor symptomatology, and their interaction with their environment can be very complex. 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 (1966-April 2007), EMBASE (1974-2000), CINAHL (1982-April 2007), Psycinfo (1806-April 2007), Ovid OLDMEDLINE (1950-1965), ISI Web of Knowledge (1981-April 2007), National Library for Health (NLH) (April 2007), Nursing, Midwifery and Allied Health (NMAP) (April 2007), Intute: Medicine (December 2005), Proquest Nursing Journals (PNJ, 1986 - April 2007); rehabilitation databases: AMED (1985-April 2007), MANTIS (1880-2000), REHABDATA (1956-2000), REHADAT (2000), GEROLIT (1979-2000); English language databases of foreign language research and third world publications: Pascal (1984-2000), LILACS (1982- April 2007), MedCarib (17th Century-April 2007), JICST-EPlus (1985-2000), AIM (1993-April 2007), IMEMR (1984-April 2007), grey literature databases: SIGLE (1980-2000), ISI-ISTP (1982-April 2007), DISSABS (1999-2000), Conference Papers Index (CPI, 1982-2000) and Aslib Index to Theses (AIT, 1716- April 2006), The Cochrane Controlled Trials Register (Issue 2, 2007), the CenterWatch Clinical Trials listing service (April 2007), the metaRegister of Controlled Trials (mRCT, April 2007), Current controlled trials (CCT) (April 2007), ClinicalTrials.gov (April 2007), CRISP (1972-April 2007), PEDro (April 2007), NIDRR (April 2007) and NRR (April 2007) 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 is now a consensus as to UK current and best practice in occupational therapy when treating people with Parkinson's disease. We now require large well designed placebo-controlled RCTs 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

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

There is inadequate evidence to evaluate the effect of occupational therapy for people with Parkinson's disease.

Parkinson's disease is a progressive disabling neurodegenerative disease. Symptoms can include problems with movement such as being stiff, slow, and shaky, and sometimes non-motor symptoms such as problems with communication, mood, vision, and problem solving abilities. 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. The review found inadequate evidence from randomised controlled trials to evaluate the effect of occupational therapy for people with Parkinson's disease.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

巴金森氏病的職能治療

雖然巴金森氏症有藥物和手術治療,患者仍逐漸失能。這個疾病有運動及非運動的症狀,症狀和環境的互動可以極為複雜。職能治療師的角色在於支持患者並幫助他們儘可能地維持一般自我照顧、工作和從事休閒活動的能力。當日常活動已無法維持的時候,職能治療師幫助病人改變並調整他們和物理、社會環境間的關係,以形塑新而有價值的活動和角色

目標

比較對於巴金森氏症病人,職能治療和安慰劑或沒有治療(控制組)之間效果及效益的差別。

搜尋策略

相關的試驗以電子搜索的方式從MEDLINE (1966April 2007), EMBASE (1974−2000), CINAHL (1982April 2007), Psycinfo (1806April 2007), Ovid OLDMEDLINE (1950−1965), ISI Web of Knowledge (1981April 2007), National Library for Health (NLH) (April 2007), Nursing, Midwifery and Allied Health (NMAP) (April 2007), Intute: Medicine (December 2005), Proquest Nursing Journals (PNJ, 1986  April 2007); rehabilitation databases: AMED (1985April 2007), MANTIS (1880−2000), REHABDATA (1956−2000), REHADAT (2000), GEROLIT (1979−2000)這些資料庫找出。外國語及第三世界文獻的英語資料庫:Pascal (1984−2000), LILACS (1982 – April 2007), MedCarib (17th CenturyApril 2007), JICSTEPlus (1985−2000), AIM (1993April 2007), IMEMR (1984April 2007), grey literature databases: SIGLE (1980−2000), ISIISTP (1982April 2007), DISSABS (1999−2000), Conference Papers Index (CPI, 1982−2000) and Aslib Index to Theses (AIT, 1716 – April 2006), The Cochrane Controlled Trials Register (Issue 2, 2007), the CenterWatch Clinical Trials listing service (April 2007), the metaRegister of Controlled Trials (mRCT, April 2007), Current controlled trials (CCT) (April 2007), ClinicalTrials.gov (April 2007), CRISP (1972April 2007), PEDro (April 2007), NIDRR (April 2007) and NRR (April 2007),各研究的參考文獻及其他的評論文章都被檢驗。

選擇標準

只包括隨機臨床試驗,但容許半隨機分配的試驗。

資料收集與分析

數據由兩位作者分別獨立抽取出來,而有差異的地方由討論來解決。

主要結論

包含84位病人的兩個試驗被選出。雖然兩個試驗都報告了職能治療的好處,所有的進步都不大。這些試驗沒有適當的安慰治療,只用了數目不多的病人; 在一個治療中,沒有說明隨機分配的方法和分配後如何保密。這些方法學上的問題可能導致從許多方面來的偏差,從而減少研究的強度。

作者結論

考量到這些研究中明顯的方法學缺陷、受試病人的稀少、發表偏差的可能性,我們沒有足夠的證據來支持或否認職能治療在巴金森氏病的效益。現在對於巴金森氏症病人的職能治療,什麼是英國現有、最好的治療已有共識。我們現在需要大規模、設計良好的隨機臨床雙盲試驗來證明職能治療對於巴金森氏病的有效。必須選出和病人、照顧者、職能治療師還有醫師特別有關的結果評估項,而病人必須被監測至少六個月來決定益處能維持多久。這些試驗發表時必須遵循CONSORT準則。

翻譯人

本摘要由新光醫院葉旭霖翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

現在沒有適當的證據來評估職能治療對巴金森氏病的效果。巴金森氏病是一個逐漸進行、使人失能的神經退化疾病。症狀包含了動作的問題,如僵硬、行動緩慢、搖晃,有時候會有非動作的症狀,如溝通、情緒、視力,還有解決問題能力的問題。職能治療師的角色在於支持患巴金森氏病的人能夠儘可能地維持日常生活自我照顧、工作和從事休閒活動的能力。這篇評論文章找不到適當的證據來評估職能治療對巴金森氏病的效果。