None listed
Conditions
Brief summary
Impaired hand function is a common cause of everyday disability for people with Parkinson’s disease (PD) and can contribute to difficulties in work and leisure activities and daily tasks such as personal care and dressing. Changes in dexterity are also closely associated with reduced quality of life. Despite this, there is little evidence to guide physiotherapy or occupational therapy management of this problem. The primary aim of this pilot randomised controlled trial is to investigate the whether this novel home-based training program, targeted to improving hand function in people with PD, is feasible and acceptable to participants. Participants will be randomly allocated into a training group or a usual care group. The training group will undertake a home-based hand training program and the control group will continue with their usual care. Participants in the training group will be provided with home exercise instructions using an online exercise prescription application with uploaded exercises and will be asked to complete the training for 30 minutes, three times a week for four weeks, The training program will be monitored remotely once a week via telerelerehabilitation. Following the 4-week program there will be two further 30-minute telerehabilitation coaching sessions at 8 and 12 weeks. Main outcome measures relate to feasibility and include recruitment and retention, participant adherence and satisfaction with the program, and adverse events. Secondary outcomes are associated with the effectiveness of the program and include assessment of fine hand skills and self-reported hand function. Participants will be assessed before randomisation (baseline), post-training (4 weeks), and at 12 weeks and 24 weeks. We hypothesise that the study will show good feasibility with strong retention, adherence and high satisfaction with the program.
Interventions
The intervention is a 4-week hand training program based on motor learning principles and delivered by registered physiotherapists and/or occupational therapists trained in the program. In accordance with motor skill learning and task-related training theory, each participant's home program will be individualised and appropriately progressed to maintain sufficient challenge.
Step 1. Introduction to the program.
The participant will be introduced to their individualised training program and the
The intervention is a 4-week hand training program based on motor learning principles and delivered by registered physiotherapists and/or occupational therapists trained in the program. In accordance with motor skill learning and task-related training theory, each participant's home program will be individualised and appropriately progressed to maintain sufficient challenge. Step 1. Introduction to the program. The participant will be introduced to their individualised training program and the technology in a single one-hour face-to-face session in their home. The therapist will provide participants with home exercise instructions using an online exercise prescription application (Physitrack® https://www.physitrack.com) with uploaded tailored exercises (video and description). These videos have been developed by the researchers and uploaded to the Physitrack software. The therapist will individualise the home program by choosing videos based on the participant's difficulties and goals. Home programs will include practicing object grasp and manipulation skills, and training of daily activities which require fine manipulation e.g writing and using cutlery. 2. The 4-week intervention. Intervention group participants will be asked to complete three practice sessions of 30 minutes per week comprised of targeted exercises and activities, and will be encouraged to incorporate learned strategies into the performance of everyday tasks. Participants will access their exercise program via their own computer or smartphone or a tablet supplied by the researchers. This system will enable participants to record and monitor their exercise completion. Exercise completion will be viewed by the therapists remotely. In addition, participants will attend a weekly 30-minute telerehabilitation session with the therapist to review and progress the focused activities and provide feedback on activity performance and training. Home programs will be progressed by changing the attributes of the tasks e.g difficulty can be increased by changing the object (weight, size, texture). 3. Follow-up telerehabilitation coaching session. After the intensive 4-week program, participants will receive a single, monthly 30-minute telerehabilitation coaching session in weeks 8 and 12 to discuss progress and review transfer of skills in to everyday activities.
Sponsors
The University of Melbourne
Study design
Allocation
Randomised controlled trial
Primary purpose
Treatment
Masking
Blinded (masking used) (Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. A diagnosis of idiopathic PD confirmed by a neurologist 2. Mild to moderate PD (Hoehn & Yahr Staging Scale score of I-III in the ‘on’ phase of the medication cycle) 3. Limitations in daily hand function 4. A stable levodopa medication regime (no changes to medications in the 4 weeks before commencement of the program 5. Independent community living 6. Adequate computer proficiency to participate in web-based video conferencing 7. Sufficient comprehension of English to complete data collection, understand training instructions and give informed consent.
Exclusion criteria
1. A Deep Brain Stimulator device in situ 2. Neurological conditions other than Parkinson's disease 3. Major musculoskeletal comorbidities of the arms and/or hands
Outcome results
None listed