Who was entered into the trial?

Patients were eligible for randomisation into the trial if they had a confirmed diagnosis of idiopathic PD as defined by the UK PDS Brain Bank Criteria, and report limitations in ADL. Patients were excluded if they had dementia (as defined by the patient’s clinician), or had received occupational therapy or physiotherapy in the previous 12 months for a PD-related problem.

Were patients eligible for participation in the PD REHAB trial if they had received occupational therapy or physiotherapy in the previous 12 months for a condition unrelated to their PD diagnosis?

Yes, if the therapy was received for a condition unrelated to the patient’s PD diagnosis (for example a referral for the management of osteoarthritic joint problems), then they were still eligible for participation in the PD REHAB trial.

Following randomisation into the trial, and referral to the physiotherapy and occupational therapy departments, how long elapsed before the therapist delivered the therapy intervention?

The aim was that the initial physiotherapy and occupational therapy assessments should occur within 4 weeks of patient randomisation, with the therapy interventions ideally completed within 3 months post-randomisation.

Did each patient randomised into the treatment arm receive an assessment from both an occupational therapist and a physiotherapist?

Yes. All patients randomised into the treatment arm should have received an assessment from an occupational therapist and a physiotherapist.

Were joint initial occupational therapy and physiotherapy assessments carried out for patients randomised to therapy?

Yes, joint assessments between the two disciplines were carried out where this was routine practice or the most practical option.

Did all patients receive both occupational therapy and physiotherapy?

No. Each patient received an initial occupational therapy and physiotherapy assessment. Whether a patient then required both therapies, or just occupational therapy or physiotherapy, varied according to the findings of the initial assessments.

Were occupational therapy and physiotherapy delivered concurrently, or could one therapy follow the other?

Therapies were delivered concurrently or one after the other as long as the initial assessments were carried out within 4 weeks of patient randomisation, and both the occupational therapy and physiotherapy interventions were completed within the 3-month intervention period.

In what setting was therapy delivered?

The therapy was delivered in any setting other than inpatient i.e. the patients were living in their own homes at the time of intervention. The interventions were delivered in whatever setting was routine practice for local services. However, the setting of therapy could also be dependent on the individual goals of the patient and the equipment and resources required to deliver the treatment needed.

The PD REHAB trial investigated the provision of occupational therapy and physiotherapy for people with Parkinson’s disease who report limitations in activities of daily living. Does this mean that the intervention provided by therapists was limited to rehabilitation of activities of daily living?

The primary purpose of the study was to address activity of daily living limitations for three reasons: 

  1. Activity restriction was identified as important by people with PD and their carers;
  2. We are using change in activity of daily living restriction as our main outcome measure;
  3. We know from other populations (such as stroke) that this intervention is effective in improving quality of life and reducing carer burden.

However, it is recognised that each patient presented with very individual needs and goals, and that therapists have professional autonomy. We just asked that activity restriction be addressed first.

A framework for the content of the therapy to be delivered within the trial was provided. Did therapists limit practice to providing assessment and treatment techniques featured within this framework only?

No. The framework was devised through analysis of the current evidence base and the use of expert consensus and existed to provide a “menu” of activities and interventions that could be beneficial for the patients in the trial. It was designed to provide general guidance to therapists as we recognised that practitioners had a spectrum of experience in treating PD. Some therapists had limited experience with this patient group and so additional support could have been welcome. The framework was not prescriptive or meant to decrease therapist autonomy in any way. The interventions delivered reflected what a therapist perceived to be the best possible treatment for a patient’s individualised needs.

A dose of 5-6 visits delivered by both the occupational therapist and physiotherapist over a period of 2 months was recommended. Did the therapy delivered always match up to this recommended dose?

No. The recommended dose provided in the trial literature reflected the average dose delivered in the pilot study for PD REHAB and that reported in survey literature for occupational therapy and physiotherapy practice in current services. Again, it was not prescriptive and the dose of therapy delivered reflected a patient’s individual needs. We recognise that some patients needed more than 6 visits whilst others may have required less.