The purpose of a randomized controlled trial conducted by Tickle-Degnen and colleagues was to determine whether increasing hours of self-management rehabilitation: (a) increased benefits for health-related quality of life (HRQOL) in Parkinson's disease beyond best medical treatment; (b) whether effects persisted at 2 and 6 months of follow-up; and (c) whether targeted compared with nontargeted HRQOL domains responded more to rehabilitation. Participants on best medication therapy were randomly assigned to one of three conditions for 6 weeks intervention: (1) 0 hours of rehabilitation; (2) 18 hours of clinic group rehabilitation plus 9 hours of attention control social sessions; and (3) 27 hours of rehabilitation, with 18 in clinic group rehabilitation and 9 hours of rehabilitation designed to transfer clinic training into home and community routines. Results (N = 116) showed that at 6 weeks, there was a beneficial effect of increased rehabilitation hours on HRQOL measured with the Parkinson's Disease Questionnaire-39 summary index (P = 0.01). Benefits persisted at follow-up. The difference between 18 and 27 hours was not significant. Clinically relevant improvement occurred at a greater rate for 18 and 27 hours (54% improved) than for 0 hours (18% improved), a significant 36% difference in rates (95% CI = 20-52% difference). Effects were largest in two targeted domains: communication and mobility. More concerns with mobility and activities of daily living at baseline predicted more benefit from rehabilitation.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: Extra rehabilitation improved the lives of patients with Parkinson’s Disease. It is likely that these changes occurred more among those who were more motivated for such treatment.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: Judging from the fact that there was increased improvement in communication and mobility, the program should be expanded to include self-management training. Systematic performance of self-management skills, in turn, would be expected to produce even more significantly positive results in patients with Parkinson’s Disease.

L Tickle-Degnen et al. Self-management rehabilitation and health-related quality of life in Parkinson's disease: A randomized controlled trial. Movement Disorders, January 13, 2010.