Occt 643 Cat Evidence Table Worksheet

Name: Jenna Babcock & Chris Gutierrez
Date: 10/2/14
Focus Question: What is the effectiveness of occupational therapy on improving occupational performance, participant wellness, lifestyle modification, and to improve
quality of life in individuals with Parkinsons disease.
Rationale for inclusion/exclusion criteria applied to determine which

articles should be included in the evidence table:
Inclusion:
Publications matching the focus question population, intervention, and
outcome.
Research participants must present with clinical diagnosis of PD
Level I-II evidence (systematic review, randomized control trial, two group
nonrandomized studies)
Articles published within the last 5 years (2009-present)
Written in English
Articles were published in peer-reviewed journals
Only adult participants
Exclusion:
Articles missing one or more of the inclusion category (participant wellness, lifestyle
modification, personal control to improve quality of life)
Level III-V studies (one group nonrandomized, case descriptive statistics, single
subject design, case reports, and expert opinion)
Articles prior to 2009
Qualitative studies
Written in another language other than English
Driving
Group OT
Expressive behaviors
Author/
Study Objectives
Level/Design/ Subjects
Intervention and
Outcome Measures
Results
Study Limitations
Implications for OT
To determine
whether people with
relatively early and
mild PD have
difficulty with
cognitively
demanding IADLs.
Level II
Intervention:
Small sample size.
Cross-sectional,
descriptive design.
Nine IADLs were used

for this study:
People with
relatively early PD
demonstrated
measurable deficits
in the performance
of cognitively
demanding IADLs.
Clinical & community-based

practice of OT:
Year
Foster, 2014
1) Oven use
77 participants with PD
and 57 non-PD
participants.
2) Stovetop use
3) Sharp utensil use
4) Bill paying by check
5) Checkbook balancing
Strategies to support the

performance of IADLs &
other complex activities in
the early stages of PD may
allow people to maintain
their independence,
participation, and quality of
life longer and may even
slow the rate of functional
decline.
6) Mailing bills
7) Shopping
Program development:
8) Medication
management
Interventions focused on
activities that take place in
the home; looked at
performance of IADLs.
9) Small home repairs
Measures:
Performance Assessment
of Self-care Skills
(PASS)
MMSE for global
cognitive function
Beck Depression
Inventory II
Unified Parkinsons
Disease Rating Scale
(UPDRS)
Societal needs:
Many pts with PD may
benefit from OT services;
specific treatments for
IADLs will improve
independence.
Healthcare delivery & health

policy:
OT is an evidence-based
profession. These
interventions examined the
cognitive ability of the
individuals to accomplish
IADLs.
Education & training of OT

student:
OT students should be aware
of increasingly difficult
IADLs with PD pts and
treatment techniques.
Refinement, revision, &

advancement of factual
knowledge or theory:
Consider subdividing the cue
levels at the higher end of the
spectrum to increase
sensitivity. Exploration of
factors that distinguish those
with PD who did and did not
require cues is warranted.
Author/
Study Objectives
Intervention and
Outcome Measures
Results
Study Limitations
Implications for OT
Review RCTs
reporting on the
effectiveness of
exercise
interventions on
outcomes (physical,
psychological or
social functioning,
or quality of life) for
Level I
Intervention:
Results identified
that exercise is of
benefit to people
with PD in respect
of physical
functioning,
HRQOL, strength,
balance and gait
speed. Findings add
Participants
mainly men &
raised question if
interventions were
acceptable to
women.

practice of OT:
Year
Goodwin,
Richards, Taylor,
& Campbell,
2008
Systematic review and

Meta-Analysis
While looking at multiple

studies, two of the studies
evaluated an exercise
intervention against a
non-exercise control,
another compared two
different exercise
Exercise is critical to
improve PD pts QOL.
people with PD.
Each RCT had a

different amount of
participants within their
study.
interventions and another

study compared three
different exercise
interventions.
to the growing body

of evidence
regarding the
effectiveness of
physiotherapy for
people with PD.
Evidence from this study
showed that there are many
benefits of utilizing exercise
with individuals with PD.
Measures:
Modified Jadad score
Societal needs:
Many PD adults do not
exercise due to difficulty
regarding mobility. Specific
exercises will help pts
improve mobility.

policy:
It is important to implement
exercise to PD adults in order
to increase strength and
balance.

student:
of which strength and
balance exercises are
beneficial for PD pts.

Future research needs to

establish what elements
constitute an optimal
exercise intervention for
people with PD such as the
dosage, component parts of
intervention, and the targeted
stage of the disease. This is
of particular importance
given the deteriorating nature
of this condition.
Author/
Study Objectives
Intervention and
Outcome Measures
Results
Study Limitations
Implications for OT
To investigate
whether body
weight-supported
treadmill training
(BWSTT) is of
long-term benefit
for patients with
Parkinsons disease.
Level I
Intervention:
The BWSTT group

had significantly
great improvement
over the PT group in
gait.. This was the
same for months 2
and 3 but at the 4
month mark.
Small sample size

practice of OT:
Year
Miyai, Fujimoto,
Yamamoto,
Ueda, Saito,
Nozaki, & Kang,
20
RCT targeting
functional ambulation.
24 PD pts (12 men, 12

women) who
experienced freezing
phenomenon during
gait.
Pts were randomized to

receive either 45-minute
sessions of BWSTT or
45-minutes sessions of
conventional PT 3 days a
week for 1 month, for a
total of 12 sessions. Gait
speed and the number of
steps taken for a 10-m
walk were done at
baseline, 1, 2, 3, 4, 5, and
6 months.
Measures:
Unified Parkinsons
(UPDRS)
BWSTT has a lasting effect

on gait disturbance in PD
patients. BWSTT
specifically improved shortstep gait, which is a clinical
characteristic of PD, beyond
the time of the intervention.
Improvement in the gait of a
PD individual helps for
functional ambulation to
complete many ADL and
IADLs.
Societal needs:
Many PD pts struggle with
short-step gait. Specific type
of step training would be an

effective treatment technique
for ambulation.

policy:
BWSTT was specifically
effective in improving shortstep gait of PD patients. It is
possible that BWSTT
induces implicit motor
learning by enhancing such
alternative brain networks.

student:
of BWSTT treatment
techniques for adults with
PD.

To determine whether
reorganization of motorrelated areas also occurs
consistently after BWSTT.
Author/
Study Objectives
Intervention and
Outcome Measures
Results
Study Limitations
Implications for OT
PD has a profound
Level I
Intervention:
This study
Small sample size.
Year
Meek, Morgan,
Walker,
Furmston,
Aragon,
Birleson, &
Sackley, 2010
impact on a persons
ability to carry out
self-care and ADLs
resulting in
increased
dependence.
A pilot RCT
investigating
occupational therapy
for people with
Parkinsons disease
exhibiting difficulties
with activities of daily
living.
19 participants received
OT. The intervention log
demonstrated that a large
proportion of therapist
visits involved equipment
provision/environmental
adaptation,
mobility/transfers/ADL
training,
review/discussion, and
the teaching of
techniques/provision of
education.
confirmed the
feasibility and
acceptability of an
individualized,
community-based
OT intervention for
people with PD
experiencing
difficulties with
ADLs.
practice of OT:
Individualized and
community-based OT
treatment utilizing adaptation
and education is beneficial
for adults with PD.
Individualized OT treatment
regarding ADLs is beneficial
for pts with PD.
Measures:
Nottingham Extended
Activity of Daily Living
Scale (NEADL)
Rivermead Mobility
Index (RMI)
Unified Parkinsons
(UPDRS)
Parkinsons Disease
Questionnaire 39 (PDQ39)
EuroQol-EQ-5D (EQ5D)
Societal needs:
Many adults with PD are not
able to conduct ADLs
independently and need
assistance from adaptation
techniques and
modifications.

policy:
Evidence suggests that
individual OT treatments
regarding environmental
modifications/transfers/ADL
training/education are
effective for PD pts.
student:
of which ADLs are difficult
for each PD pt and
knowledge of adaptations for
environment.

Although the intervention log
was successful in capturing
some broad aspects of
treatment, the trial also
highlighted that techniques
used during therapy may be
useful.
Author/
Study Objectives
Intervention and
Outcome Measures
Results
Study Limitations
Implications for OT
Determine if
increasing hours of
self-management
rehab had increasing
benefits for healthrelated quality of
life (HRQOL) in PD
beyond best medical
treatment.
Level I
Intervention:
Six weeks there was

a beneficial effect of
increased rehab
hours on HRQOL
measured with the
Parkinsons Disease
Questionnaire-39
summary index.
Benefits persisted at
follow-up.
This study did not

differentiate the
active
contributions of
rehab methods.

practice of OT:
Year
Tickle-Degn,
Ellis, SaintHilaire, Thomas,
& Wagenaar,
2010
117 pts assessed on

HRQOL at baseline,
immediately post
intervention at six
weeks, and at two
months and six months
follow-up.
Each group clinic session

involved physical
exercises, speech
exercises, functional
training, and a discussion
about self-management
strategies. Pts were
taught to problem solve
by asking themselves a
key question: Can I
change something about
myself, about the task, or
about the environment to
improve my ability?
Implementation of various
exercises and education
provided pts to become more
efficient with selfmanagement.
This intervention allowed pts
to utilize tools in order to
problem solve.
Societal needs:
PD adults tend to be deficit
with ADLs. Education and
training helps improve adults
function.
Measure:
Parkinsons Disease
Questionnaire-39
Summary index score

policy:
Each intervention session
was effective in improving
pts with problem solving
when conducting functional
activities.

student:
of which education
techniques enable PD pts to
conduct ADLs more
efficiently.

Improvement rates
anticipated to be 20% to 53%
greater than for medication
alone.
Author/
Study Objectives
Intervention and
Outcome Measures
Results
Study Limitations
Implications for OT
Year
Protas, Mitchell,
Williams,
Qureshy,
Caroline,& Lai,
2005
To assess the benefit

of gait and step
perturbation training
in individuals with
PD.
Level I
18 men with idiopathic

PD diagnosed at the
Houston VA
Parkinsons Disease
Research, Education
and Clinical Center
(PADRECC).
Intervention:
Subj were tested in the
morning and asked to
take meds 1 hr prior to
the test in order to assure
that subjects were at their
best. Gait was assessed
by gait speed, cadence, &
stride length. Pt
completed 2 trials on the
walkway and average
speed calculated. Pts
received training 3 times
per wk for 8 wks.
Substantial
reduction occurred
in falls in the
trained group, but
not in the control
group. Gait speed
increased in the
trained group but
not in control group.
Stride lengths
increased for the
trained group but
not for the control
group.
Sample size was

small, especially
given the
variability in
individuals with
PD.

practice of OT:
Gait and step perturbation
training with PD pts is
effective for reducing falls
when ambulating in
environment.
Evidence should be used
regarding the step and gait
training when conducting
ADLs and IADLs.
Measures:
Self-report for falls
Neurobehavioral
Cognitive Status
Examination
Hoehn & Yahr staging
Societal needs:
Pts with PD often have an
increased risk of falling and
decreases their self-efficacy
of moving in their
environment, decreasing
their QOL.

policy:
Interventions reduced pts
risk of falling and increased
strength and balance. This
rehab tool can be
implemented with OT
sessions.

student:
of training and
implementation of step and
gait techniques when
conducting ADLs and
IADLs.

Due to this studys small
sample size, further research
should focus on larger
sample size.
Author/
Study Objectives
Intervention and
Outcome Measures
Results
Study Limitations
Implications for OT
To perform a pilot
trial of OT to
optimize functional
independence in PD
in order to assess
accrual/withdrawal
rates, acceptability,
outcome measures,
& inform samplesize calculation.
Level I
Intervention:
Minimally relevant
changes in NEADL
and PDQ-39.
The small pilot

study was not
intended to
provide definitive
data on the
effectiveness of
occupational
therapy for ADL
problems in
Parkinsons
disease, rather to
inform design of
future RTCs.

practice of OT:
Year
Clarke,
Furmston,
Morgan, Patel,
Sackley, Walker,
& Wheatley,
2009
RCT with masked

assessment of standard
community-based
individual OT targeting
functional
independence and
mobility.
Pts were divided into two

groups. One group was
assessed at home and
then received six home
treatments sessions over
2 months. The other
group would not receive
any treatment sessions.
At 2 and 8 months post
randomization,
assessments were posted
to all pts for selfcompletion.
Benefits of OT functional
dependency is cost-effective
and better service provision
for pts with PD.
This intervention had a short
time frame. More effective
OT sessions are needed to
determine effectiveness of
OT services over longer time

period.
Measures:
Nottingham Extended
Activity of Daily Living
Scale (NEADL)
Rivermead Mobility
Index (RMI)
Unified Parkinsons
(UPDRS)
Parkinsons Disease
Questionnaire 39 (PDQ39)
EuroQol-EQ-5D (EQ5D)
Hospital Anxiety and
Depression Scale
(HADS)
Societal needs:
PD pts are often deficit with
ADLs in their homes.
Specific home treatment
sessions provide pts with
increased independence.

policy:
Home-based OT is a
common treatment, and
insurance companies
regularly pay for this
intervention. This study does
not have any implications in
regards to healthcare delivery
or health policy, beyond
offering additional evidence
that home-based OT is an
effective treatment for pts
with PD.

student:
OT students need to be aware
of how to implement
environmental modifications
for individualized clients and
their homes.

The results of the study
reviewed here support the
use of home-based OT
treatment as an intervention
for pts with PD. However,
this small pilot study was not
intended to provide definitive
data on the effectiveness of
occupational therapy for
ADL problems in PD, rather
to inform design of future
RTCs.
Author/
Study Objectives
Intervention and
Outcome Measures
Results
Study Limitations
Implications for OT
PD affects pts
occupational
performance; this
study aims to
identify if OT is
beneficial for PD
pts.
Level I
Intervention:
Primary outcome
measures at three
months
demonstrated a
small positive trend
in favor of the
intervention group.
COPM measure
indicated that pts &
caregivers were
mostly or absolutely
satisfied with the
results of the
intervention. Was
not statistically
significant.
OTs treated a
relatively small
number of pts
each. OTs stated
interventions need
to be longer than
10 weeks.

practice of OT:
Year
Sturkenboom,Gr
aff, Borm,
Veenhuizen,
Bloem,
Munneke, &
Nijhuis-van der
Sanden, 2013
Random allocation of
intervention 2:1
control, & an assessorblinded postintervention
measurement at three
months followed by a
qualitative evaluation
of the intervention
procedures & outcome.
OT services included
individualized
interventions for pts &
caregivers. The control
group did not receive any
OT intervention until
after the three months
measurement.
Measures:
COPM
AMPS
Consumer Quality index
OT interventions lead PD pts

to more self-efficacy w/
occupational performance.
Based on this study, the
intervention of individualized
OT services should be
implemented for pts with PD.
The results indicate that pts
and caregivers were
absolutely satisfied with the
treatment.
Societal needs:
PD adults often function
within their own homes and
would benefit from homebased therapy compared to a
traditional rehab facility.

policy:
Results indicate the
satisfaction of pts and
caregivers with OT
interventions, however,
treatments need to be longer
than 10 weeks.

student:
of how to conduct home
modification evaluations for
PD pts and develop
individualized treatment
plans.

Due to this studys small
sample size and limited
amount of time, further
research is needed to
determine if interventions
implemented will continue
longer than 10 weeks.
Author/
Study Objectives
Intervention and
Outcome Measures
Results
Study Limitations
Implications for OT
Pts QOL when

performing
ADLs/IADLs with
PD.
Level I
Intervention:
At 3 and 6 months,
intervention group
had significantly
better self-perceived
performance on
prioritized activities
(COPM) compared
to the control group.
Control group was

not offered an
intervention,
cannot exclude if
placebo effects
contributed to the
benefits
experienced by pts
in the intervention
group. Results
presented here
focused on
efficacy.

practice of OT:
Year
Sturkenboom,
Graff, Hendriks,
Veenhuizen,
Munneke,
Bloem, & der
Sanden, 2014
RCT in ten hospitals,

using assessment at 3
and 6 months. 191
eligible pts who were
randomly assigned and
have PD and selfreported difficulties in
ADLs along with
caregivers.
Intervention group
received 10 weeks of
home-based OT.
Intervention strategies
were individually tailored
to alleviate the problems
in activities prioritized by
the pt.
Measures:
COPM for perceived
activity performance
OT intervention group
significantly improved pts
self-perceived performance
in meaningful daily
activities.
It would be beneficial to
implement intervention
strategies based on the pts
prioritized problems. These
interventions are individually
tailored to alleviate problems
associated with PD.
Societal needs:
Many PD pts have different
priorities regarding ADLs
that are most affected. Homebased OT treatments are
most effective.
policy:
Results of this study
indicated better selfperceived performance on
prioritized activities.

student:
of how PD affects each pt
individually in their home
environment and how to
implement adaptations in
order to be more efficient w/
ADLs.

In order for PD pts to feel
self-efficacy when
performing ADLs, OT
treatments need to be
measured and researched.

Occt 643 Cat Evidence Table Worksheet

Caricato da

Informazioni sul documento

Descrizione originale:

Titolo originale

Copyright

Formati disponibili

Condividi questo documento

Condividi o incorpora il documento

Opzioni di condivisione

Hai trovato utile questo documento?

Questo contenuto è inappropriato?

Copyright:

Formati disponibili

Occt 643 Cat Evidence Table Worksheet

Caricato da

Copyright:

Formati disponibili

Name: Jenna Babcock & Chris Gutierrez

Rationale for inclusion/exclusion criteria applied to determine which

Small sample size.

Nine IADLs were used

Clinical & community-based

Strategies to support the

9) Small home repairs

Healthcare delivery & health

Education & training of OT

Refinement, revision, &

Clinical & community-based

Systematic review and

While looking at multiple

people with PD.

Each RCT had a

interventions and another

to the growing body

Healthcare delivery & health

Education & training of OT

Refinement, revision, &

Future research needs to

The BWSTT group

Small sample size

Clinical & community-based

24 PD pts (12 men, 12

Pts were randomized to

BWSTT has a lasting effect

of step training would be an

Healthcare delivery & health

Education & training of OT

Refinement, revision, &

Small sample size.

Clinical & community-based

Healthcare delivery & health

Education & training of OT

Refinement, revision, &

Six weeks there was

This study did not

Clinical & community-based

117 pts assessed on

Each group clinic session

Healthcare delivery & health

Education & training of OT

Refinement, revision, &

To assess the benefit

18 men with idiopathic

Sample size was

Clinical & community-based

Healthcare delivery & health

Education & training of OT

Refinement, revision, &

The small pilot

Clinical & community-based

RCT with masked

Pts were divided into two

OT services over longer time

Healthcare delivery & health

Education & training of OT

Refinement, revision, &

Clinical & community-based

OT interventions lead PD pts

Healthcare delivery & health