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1.  Upper-Limb Assessment in People with Parkinson Disease: Is It a Priority for Therapists, and Which Assessment Tools Are Used? 
Physiotherapy Canada  2013;65(4):309-316.
Purpose: To investigate the frequency of physiotherapy and occupational therapy assessment of the upper limb (UL) in people with Parkinson disease (PD) and to identify the impairments and activity limitations assessed and the methods used. Method: A custom-designed questionnaire was used to survey physiotherapists and occupational therapists with previous experience in managing people with PD, using targeted recruitment to invite physiotherapy conference attendees, clinicians employed in movement disorders programmes, and practitioners in neurology and gerontology to respond either on paper or online. Results: Of the 190 respondents (122 physiotherapists, 68 occupational therapists), 54% reported consistently assessing the UL. A majority (>60%) assessed impairments specific to PD, but few quantified these using standardized measures. Activity limitations, largely relating to manual dexterity, were assessed using observational analysis (61%), non-standardized timed activities (46%), and standardized outcome measures (61%), most generic or developed for evaluating other neurological conditions. More than 10% of respondents could not identify an appropriate standardized measure. Conclusions: Slightly more than half of respondents regularly assessed the UL. Respondents reported widespread use of non-standardized methods to assess PD-specific impairments. Standardized measures were more frequently used to evaluate activity limitations, but despite the unique movement disorders associated with PD, the clinimetric properties of most of the tools identified have not been established in this population. Education and further clinimetric investigation of measures in use are needed to facilitate evidence-based practice in this area.
PMCID: PMC3817870  PMID: 24396156
occupational therapy; outcome assessment (health care); Parkinson disease; upper extremity; ergothérapie; évaluation de résultats (soins de santé); maladie de Parkinson; membres supérieurs; spécialité de la physiothérapie
2.  Protocol for a home-based integrated physical therapy program to reduce falls and improve mobility in people with Parkinson’s disease 
BMC Neurology  2012;12:54.
The high incidence of falls associated with Parkinson’s disease (PD) increases the risk of injuries and immobility and compromises quality of life. Although falls education and strengthening programs have shown some benefit in healthy older people, the ability of physical therapy interventions in home settings to reduce falls and improve mobility in people with Parkinson’s has not been convincingly demonstrated.
180 community living people with PD will be randomly allocated to receive either a home-based integrated rehabilitation program (progressive resistance strength training, movement strategy training and falls education) or a home-based life skills program (control intervention). Both programs comprise one hour of treatment and one hour of structured homework per week over six weeks of home therapy. Blinded assessments occurring before therapy commences, the week after completion of therapy and 12 months following intervention will establish both the immediate and long-term benefits of home-based rehabilitation. The number of falls, number of repeat falls, falls rate and time to first fall will be the primary measures used to quantify outcome. The economic costs associated with injurious falls, and the costs of running the integrated rehabilitation program from a health system perspective will be established. The effects of intervention on motor and global disability and on quality of life will also be examined.
This study will provide new evidence on the outcomes and cost effectiveness of home-based movement rehabilitation programs for people living with PD.
Trial registration
The trial is registered on the Australian and New Zealand Clinical Trials Registry (ACTRN12608000390381).
PMCID: PMC3436761  PMID: 22799601
Parkinson’s disease; Accidental falls; Randomized controlled trial; Falls prevention
3.  Feasibility, Safety, and Compliance in a Randomized Controlled Trial of Physical Therapy for Parkinson's Disease 
Parkinson's Disease  2011;2012:795294.
Both efficacy and clinical feasibility deserve consideration in translation of research outcomes. This study evaluated the feasibility of rehabilitation programs within the context of a large randomized controlled trial of physical therapy. Ambulant participants with Parkinson's disease (PD) (n = 210) were randomized into three groups: (1) progressive strength training (PST); (2) movement strategy training (MST); or (3) control (“life skills”). PST and MST included fall prevention education. Feasibility was evaluated in terms of safety, retention, adherence, and compliance measures. Time to first fall during the intervention phase did not differ across groups, and adverse effects were minimal. Retention was high; only eight participants withdrew during or after the intervention phase. Strong adherence (attendance >80%) did not differ between groups (P = .435). Compliance in the therapy groups was high. All three programs proved feasible, suggesting they may be safely implemented for people with PD in community-based clinical practice.
PMCID: PMC3236432  PMID: 22191076
4.  Quantifying the profile and progression of impairments, activity, participation, and quality of life in people with Parkinson disease: protocol for a prospective cohort study 
BMC Geriatrics  2009;9:2.
Despite the finding that Parkinson disease (PD) occurs in more than one in every 1000 people older than 60 years, there have been few attempts to quantify how deficits in impairments, activity, participation, and quality of life progress in this debilitating condition. It is unclear which tools are most appropriate for measuring change over time in PD.
Methods and design
This protocol describes a prospective analysis of changes in impairments, activity, participation, and quality of life over a 12 month period together with an economic analysis of costs associated with PD. One-hundred participants will be included, provided they have idiopathic PD rated I-IV on the modified Hoehn & Yahr (1967) scale and fulfil the inclusion criteria. The study aims to determine which clinical and economic measures best quantify the natural history and progression of PD in a sample of people receiving services from the Victorian Comprehensive Parkinson's Program, Australia. When the data become available, the results will be expressed as baseline scores and changes over 3 months and 12 months for impairment, activity, participation, and quality of life together with a cost analysis.
This study has the potential to identify baseline characteristics of PD for different Hoehn & Yahr stages, to determine the influence of disease duration on performance, and to calculate the costs associated with idiopathic PD. Valid clinical and economic measures for quantifying the natural history and progression of PD will also be identified.
Trial Registration
PMCID: PMC2649133  PMID: 19152709

Results 1-4 (4)