School of Occupational Therapy

Touro University Nevada

OCCT 643 Systematic Reviews in

Occupational Therapy

CRITICALLY APPRAISED TOPIC (CAT)

WORKSHEET

Focused 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.

Prepared By:
Jenna Babcock OTS (OT15.Jenna.Babcock@nv.touro.edu)
Chris Gutierrez OTS (OT15.Christy.Gutierrez@nv.touro.edu)
Department of Occupational Therapy
Touro University Nevada
874 American Pacific Dr.
Henderson, NV 89014

Date Review Completed:

October 13, 2014

Clinical Scenario:
Parkinsons Disease (PD) is a progressive degenerative neurological movement disorder that
affects approximately 6.3 million people worldwide. Although it typically develops after the age
of 65, about 15% of people with the condition develop "young-onset" PD before reaching age

50. As PD progresses, it becomes increasingly disabling, making daily activities like bathing or
dressing difficult or impossible. Many of the symptoms of PD involve motor control, the ability
to control your muscles and movement (Parkinsons Disease Foundation, 2013).

Physical activity levels decline with age and thus contribute to functional decline. Individuals
with PD display a reduction in physical activity levels more quickly than their healthy peers. PD
is associated with dementia and difficulty performing activities of daily living (ADLs).
Occupational therapy has shown positive benefits in motor and quality of life for the duration of
interventions (Rao, 2010).

Summary of Key Findings:

Summary of Levels I, II and III:
All participants improved in their performance of IADLs which may allow for
individuals with PD to maintain their independence, participation, and quality of life
longer.
A systematic review and meta-analysis showed the benefits of exercise to people with
PD in respect to physical functioning, health-related quality of life, strength, balance,
and gait speed. Findings add to the growing body of evidence regarding the
effectiveness of physiotherapy for people with PD.
The effects of body weight-supported treadmill training lasted for 4 months and were
specifically effective in improving short-step gait of PD patients.
A pilot RCT study confirmed the feasibility and acceptability of an individualized,
community-based OT intervention for people with PD experiencing difficulties with
ADLs.
A group of 117 patients were involved in physical exercises, speech exercises,
functional training, and a discussion self-management; improvement rates showed that
rehab can be anticipated to be 20% to 53% greater than just using medication alone to
treat PD.
Substantial reduction in falls with men who received gait training that worked on their
speed, cadence, and stride length. This increases their self-efficacy of moving within
their environment and quality of life.
The benefits of occupational therapy functional dependency are cost-effective and better
service provision for individuals living with PD.
Inventions used in occupational therapy services for patients with PD and their caregiver
resulted in mostly or absolutely satisfied results of the intervention.
Occupational therapy interventions significantly improved patients self-perceived
performance in meaningful daily activities.

Summary of Level IV and V:

Not included in this review.

Contributions of Qualitative Studies:

Not included in this review.

Bottom Line for Occupational Therapy Practice:

The clinical and community-based practice of OT:
Occupational therapy strategies support the performance of ADLs, IADLs, and other complex
activities in the early stages of PD. OT may allow people to maintain their independence,
participation, and quality of life longer and may even slow the rate of functional decline (Foster,
2014, Level II).
Program development:
Interventions focused on activities that take place in the home increased functional performance.
Group therapy should be considered for social and psychosocial benefits as well (Meek, Morgan,
Walker, Furmston, Aragon, Birleson, & Sackley, 2010, Level I).
Societal Needs:
Many PD adults do not exercise due to difficulty regarding mobility. Specific exercises will help
patients improve mobility so they are able to conduct ADLs independently and with the
assistance from adaptation techniques and modifications (Goodwin, Richards, Taylor, &
Campbell, 2008, Level I).
Healthcare delivery and policy:
There is limited research regarding specific occupational therapy interventions for individuals
with PD. Additional evidence needs to be collected before informing policy makers regarding
the effectiveness of the specific OT interventions (Hindle, Petrelli, Clare & Kalbe, 2013).
Education and training of OT students:
Occupational therapy interventions should be part of an entry-level curriculum. Advanced
training regarding specific diagnoses and modalities of physical activity should be part of
continuing education (Baatile, Langbein, Weaver, & Maloney, 2000).

Refinement, revision, and advancement of factual knowledge or theory:

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
(Goodwin, Richards, Taylor, & Campbell, 2008, Level I).

Review Process:
Based on interest in neurodegenerative disorders and education, a focused question was
developed.
Preliminary research was conducted to see if population, intervention, and outcome (PIO) was
addressed in literature.
The focus question was reviewed and approved by the course instructor.
Key terms were identified. Subject headings screened for each key term and established in the
databases.
Individual database searches were conducted to locate abstracts that met population,
intervention, and outcome of focused question.
After reviewing located abstracts, full-text articles were downloaded as PDF documents and
printed for review.
Comprehensive literature search submitted to instructor.
Instructor verified literature search to ensure a comprehensive search was completed.
Inclusion/exclusion set based on available evidence answering focused question.
All articles meeting inclusion criteria reviewed and appraised in an evidence table.
Course instructor reviewed evidence table for accuracy.
CAT completed by M.S. of occupational therapy students.

Procedures for the Selection and appraisal of articles:

Inclusion Criteria:
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 Criteria:
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

Search Strategies:
Categories

Key Search Terms

Patient/Client Population

Parkinsons disease, neurological conditions, Parkinson's

disease patients, exercise, balance, occupational therapy,
lifestyles and health, wellness

Intervention

Physical activity, exercise, physical therapy modalities, home

OT to improve QOL

Outcomes

Self-management and independence for ADLs, balance, and

fall prevention

Databases and Sites Searched

AJOT, CINAHL PLUS, Cochrane Database of Systematic Reviews, EBSCO, PubMed

Quality Control/Peer Review Process:

Search terms were developed with consultations with each student and course instructor.

Searches in all databases conducted.

Comprehensive literature search completed and reviewed by course instructor.
Inclusion/exclusion criteria applied to evidence for appraisal.
Evidence table completed containing all included articles relevant to focus question.
Course instructor reviewed evidence table for thoroughness and accuracy.
Occupational therapy students completed CAT on selected topic.

Results of Search:
Summary of Study Designs of Articles Selected for Appraisal:
Level of
Evidence

Study Design/Methodology of Selected Articles

Number of Articles
Selected

Systematic reviews, meta-analysis, randomized

controlled trials

II

Two groups, nonrandomized studies (e.g., cohort,

case-control)

III

One group, nonrandomized (e.g., before and after,

pretest, and posttest)

IV

Descriptive studies that include analysis of outcomes

(single subject design, case series)

Case reports and expert opinion, which include

narrative literature review and consensus statements

Qualitative Studies

Other

TOTAL:

Limitations of the Studies Appraised:

Levels I, II, and III

Small sample size (article)

Participants mainly men & raised question if interventions were acceptable to women.
Study did not differentiate the active contributions of rehab methods.
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.
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

Levels IV and V
Not included in this review.

Articles Selected for Appraisal:

Clarke, C. E., Furmston, A., Morgan, E., Patel, S., Sackley, C., Walker, M., & Wheatley, K.
(2009). Pilot randomised controlled trial of occupational therapy to optimise
independence in Parkinson's disease: the PD OT trial. Journal of Neurology,
Neurosurgery & Psychiatry, 80(9), 976-978.

Foster, E. R. (2014). Instrumental activities of daily living performance among people with
parkinsons disease without dementia. American Journal of Occupational Therapy, 68(3),
353-362.

Goodwin, V. A., Richards, S. H., Taylor, R. S., Taylor, A. H., & Campbell, J. L. (2008). The
effectiveness of exercise interventions for people with Parkinson's disease: A systematic
review and metaanalysis. Movement Disorders, 23(5), 631-640.

Meek, C., Morgan, E., Walker, M. F., Furmston, A., Aragon, A., Birleson, A., & Sackley, C. M.
(2010). Occupational therapy to optimise independence in Parkinson's disease: the
designing and recording of a randomised controlled trial intervention. The British
Journal of Occupational Therapy, 73(4), 178-185.

Miyai, I., Fujimoto, Y., Yamamoto, H., Ueda, Y., Saito, T., Nozaki, S., & Kang, J. (2002). Longterm effect of body weight-supported treadmill training in Parkinsons disease: A
randomized controlled trial. Archives Physical Medicine Rehabilitation, 83(10), 1370-3.

Protas, E. J., Mitchell, K., Williams, A., Qureshy, H., Caroline, K., & Lai, E. C. (2005). Gait and
step training to reduce falls in Parkinson's disease. NeuroRehabilitation, 20(3), 183-190.

Sturkenboom, I. H., Graff, M. J., Borm, G. F., Veenhuizen, Y., Bloem, B. R., Munneke, M., &
Nijhuis-van der Sanden, M. W. (2013). The impact of occupational therapy in Parkinsons
disease: A randomized controlled feasibility study. Clinical rehabilitation, 27(2), 99-112.

Sturkenboom, I. H., Graff, M. J., Hendriks, J., Veenhuizen, Y., Munneke, M., Bloem, B. R., &
der Sanden, M. W. (2014). Efficacy of occupational therapy for patients with Parkinson's
disease: a randomised controlled trial. The Lancet Neurology, 13(6), 557-566.

TickleDegnen, L., Ellis, T., SaintHilaire, M. H., Thomas, C. A., & Wagenaar, R. C. (2010).
Selfmanagement rehabilitation and healthrelated quality of life in Parkinson's disease: A
randomized controlled trial. Movement Disorders, 25(2), 194-204.

Other References:
Baatile, J., Langbein, W. E., Weaver, F., Maloney, C., & Jost, M. B. (2000). Effect of exercise
on perceived quality of life of individuals with parkinson's disease. Journal of
Rehabilitation Research & Development, 37(5), 529-534.
Hindle, J. V., Petrelli, A., Clare, L., & Kalbe, E. (2013). Nonpharmacological enhancement of
cognitive function in parkinson's disease: A systematic review. Movement Disorders:
Official Journal of the Movement Disorder Society, 28(8), 1034-1049.
doi:10.1002/mds.25377
Rao, A. K. (2010). Enabling functional independence in Parkinson's disease: update on
occupational therapy intervention. Movement Disorders, 25(S1), S146-S151.