Clinical practice guidelines recommend interdisciplinary rehabilitation for people with Parkinson’s disease (PD) by a team including occupational therapy (OT), speech therapy (ST), and physical therapy (PT). In early PD, proactive rehabilitation includes (1) baseline evaluations, (2) exercise prescription and self-management advice, and (3) addressing early impairments in walking, balance, voice, dexterity, and occupational performance. The purpose of this study is to describe the delivery patterns, patient characteristics, and baseline performance of people referred to proactive rehabilitation at Shirley Ryan AbilityLab.
Description of Study Activities
Retrospective data from electronic medical records were extracted manually. Patients were included if they were referred to the proactive rehabilitation program for PD.
The first stage of this study focused on the utilization of occupational therapy (OT). Descriptive statistics were used to characterize patient demographics and OT measures including basic activities of daily living (BADL), instrumental activities of daily living (IADL), nine-hole peg test, grip and pinch strength. A total of 72 patients were evaluated in the following clinical combinations: 17 PT/OT/ST, 8 ST/PT, 3 OT/PT, 2 OT/ST, 0 OT, 4 ST, and 38 PT. 22 patients were seen in OT (73% male, 68 ± 11 years old). 77% of these individuals were in HY stage 1-2, and 73% were within 5 years of diagnosis. Most individuals (91%) reported requiring increased time for at least one BADL. Writing and keyboarding were problems for 45% and 32% of individuals, respectively. Average nine-hole peg test values were 33 seconds (L) and 34 seconds (R). Average grip and pinch strength measures were 61.7 lbs. (L), 61.8 lbs. (R), 17 lbs. (L) 17.8 lbs. (R), respectively. Eighteen patients attended one 90 minute session, 3 patients completed 1 additional visit, and 1 patient completed 5 additional visits. OT is the least common area of proactive rehabilitation. While the majority of people evaluated were relatively early in their disease, they presented with impairments in dexterity and hand strength.