How to evaluate effects of occupational therapy - lessons learned from an exploratory randomized controlled trial

Area of Science:

• Neurology
• Rehabilitation Medicine
• Occupational Therapy

Background:

• Occupational therapy (OT) is commonly used for Parkinson's disease (PD) patients.
• Evidence for OT's effectiveness in improving PD-related activity limitations is limited.
• Current outcome measures may not fully capture OT's benefits.

Purpose of the Study:

• To assess the efficacy of OT in improving activity limitations for Parkinson's disease patients.
• To evaluate the validity of various outcome parameters, including clinical scales and quantitative motor assessments, in reflecting OT efficacy.

Main Methods:

• An exploratory, randomized-controlled, single-blinded trial involving 40 PD patients (Hoehn & Yahr stage 2-3).
• Intervention group received 10 weeks of OT focused on motor aspects of activity limitations.
• Outcome measures included MDS-UPDRS parts II and III, and quantitative motor assessments (Pegboard, Q-Motor tremormotography/digitomotography).

Main Results:

• Patients receiving OT reported subjective improvements in activity limitations, with a significant increase in MDS-UPDRS part II scores (p=0.030).
• Clinician-based ratings and quantitative motor assessments did not reveal significant improvements in motor impairment or fine motor control.
• A discrepancy was observed between patient-reported outcomes and objective clinical/motor assessments.

Conclusions:

• Occupational therapy may lead to individualized improvements in activity limitations as perceived by Parkinson's disease patients.
• The findings challenge the suitability of current gold-standard assessments for measuring OT effectiveness in PD trials.
• Further research is needed to refine outcome measures for occupational therapy interventions in Parkinson's disease.