Table 2 Study Characteristics & Results
Study Author, Year, Country | Population & notable exclusions | Sample Participants (n); Age; H&Y Stage | Intervention & Comparator | Outcome Primary (underlined) & Relevant Secondary (Measure) | Results | Risk of Bias | |
|---|---|---|---|---|---|---|---|
Design: Randomised Controlled Trials | |||||||
Dobkin [19], 2020 USA | People with PD + depression (current); age 35-85 yr; stable condition; family/friend willing to participate. Excluded: MoCA< 21, medically unstable or primary psychotic/bipolar/substance abuse disorder. | n = 72 Mean age 65 yrs. H&Y not given | PD-informed telephone-Cognitive Behaviour Therapy (T-CBT) with self-management in addition to ‘enhanced TAU’ vs ‘Enhanced’ treatment as usual: TAU+ clinical monitoring by study staff & provision of a resource list. | Difference in mean improvement CBT vs TAU (95% CI) | Some concerns | ||
Depression (HAM-D) | 6.88 (4.73–9.03) at end of intervention 5.15 (2.99–7.31) at 6 month follow-up F4,249 = 14.89, p < 0.0001 at end of intervention; and at 6-month follow-up (p < 0.0001) | ||||||
QoL (Mental Health composite Score (MCS) of the SF-36) | 4.48 (−0.86 to 9.83) at end of intervention 4.70 (− 0.64 to 10.04) at end of 6 month follow-up F4,241 = 3.62, p = 0.007 | ||||||
Other reported outcomes: Responder status (Clinical Global Impression Improvement Scale); Depression severity (BDI); Anxiety (HAM-A); Negative thinking (Inference Questionnaire) | |||||||
Navarta-Sanchez, [20] 2020 Spain (cluster randomisation) | People with PD (any stage), fluent in Spanish, and their informal caregivers Excluded: Cognitive impairment. | n = 140 (PD) + 127 (carers) Mean age, PD: 75 yrs. (intervention) & 72 yrs. (control). Mean age, carers: 67 yrs. (intervention) & 64 yrs. (control). H&Y range I-V (majority I-III) | Psychoeducation vs Control: education only | Mean (SD) pre/post/6 months follow-up for intervention vs control | High | ||
QoL (PDQ-39) | Pre 21.38 (14.12), post 20.42 (14.78), 6 m 24.61 (18.54) vs pre 19.44 (12.17), post 17.05 (12.87), 6 m 23.69 (14.92) Time effect 8.49 (p < 0.001), time*group interaction 0.59 (p = 0.554) | ||||||
Caregiver QoL (SQLC) | Pre 119.11 (22.55), post 120.39 (23.68), 6 m 119.64 (21.86) vs pre 117.83 (23.49), post 117.02 (23.57), 6 m 114.00 (27.33) Time effect 0.96 (p = 0.386), Time*group interaction 1.89 (p = 0.157) | ||||||
Psychosocial adjustment (PAIS-SR) | People with PD: Pre 35.05 (16.90), post 32.29 (16.42), 6 m 37.80 (18.34) vs pre 34.12 (19.59), post 30.68 (17.72), 6 m 37.82 (17.34) Time effect 8.28 (p = 0.001), Time*group interaction 0.14 (p = 0.868) Caregivers: Pre 32.41 (16.33), post 27.70 (14.51), 6 m 30.70 (13.04) vs pre (28.31 (17.06), post 24.36 (14.87), 6 m 27.29 (18.91) Time effect 3.88 (p = 0.026), time*group interaction 0.03 (p = 0.967) | ||||||
Coping skills (BRIEF COPE Scale) | People with PD: Pre 47.36 (9.18), post 46.34 (10.28), 6 m 46.58 (12.13) vs pre 47.36 (11.21), post 46.10 (11.39), 6 m 46.28 (11.30) Time effect 0.76 (p = 0.471), Time*group interaction 0.01 (p = 0.988) Caregivers: Pre 46.41 (10.39), post 48.14 (9.53), 6 m 44.92 (8.18), vs pre 47.68 (10.21), post 49.87 (10.51), 6 m 45.13 (10.82) Time effect 5.95 (p = 0.004), time*group interaction 0.25 (p = 0.781) | ||||||
Yuen, 2020 [16] China | People age 18-80 yrs., with PD. Excluded recent use of antidepressants, recent suicide attempt, history of psychosis, severe comorbidity, H&Y stage ≤4 | n = 36 Median age: 60 yrs. (intervention) & 65 yrs. (control) H&Y not given. | Conduction Exercise & Self-Accupressure vs usual care + 2 sessions of “health related talk” | Mean +/− SE intervention vs control | Some concerns | ||
Quality of Life (Chinese PDQ-39) | Pre 43.32(+/−4.75), post 41.32 (+/−5.22), vs pre 40.64(+/−5.31), post 41.07(+/−6.33) Adjusted mean difference between group: −2.25+/− 4.77 (−11.94 to 7.45); p = 0.64 | ||||||
Other reported outcomes: Custom-designed questionnaire: a short form of Non-motor Symptom Scale. | |||||||
Van Der Kolk, 2019 [21] The Netherlands | People age 30-75 yrs. with PD H&Y stage I-II, stable medication. Excluded: B-blocking or anti-pscychotic medication, comorbidity that makes them unfit to do the exercises, recent psychiatric disease, dementia, MMSE< 24, unable to perform computer task, no internet at home. | n = 130 Mean age 59 yrs. (intervention) & 59 yrs. (control) H&Y 94–95% were stage 2, (range 1–2). | Home-based gamified exercise on a stationary home-trainer vs Active Control: Stretching group Both groups had motivational app. | Intervention vs control: mean (SE) or mean (SE; 95% CI). | Low | ||
MDS-UPDRS - motor | Pre 29.5 (2.7), post 29.0 (2.5) so change of 1.3 (1.8) vs Pre 27.2 (2.7), post 31.4 (2.5) so change of 5.6 (1.9). Between group difference: −4.2 (1.3; −6.9 to −1.6), p = 0.0020 | ||||||
Quality of life (Parkinson’s Disease Questionnaire-39), | Pre 24.9 (2.2), post 26.0 (2.3) so change −0.2 (1.9) vs Pre 24.0 (2.2), post 26.3 (2.3) so change 0.0 (1.9) Between group difference: − 0.2 (1.5; −3.2 to 2.8), p = 0.91 | ||||||
Other reported outcomes Motor scores (Mini-Balance Evaluation Systems test, Timed Up and Go, Six-minute-walk test, pegboard and finger-tapping, fall frequency); Non-motor scales (Hamilton Anxiety and Depression Scale, sleep section of Scales for Outcomes in Parkinson’s disease [SCOPA], Fatigue Severity Scale, gastrointestinal section of the SCOPA Autonomic scale, Montreal Cognitive Assessment, Trial Making Test, Test of Attentional Performance), Cardiovascular fitness (VO2 max with graded maximal exercise testing). | |||||||
Atterbury 2017 [22] South Africa | People age 50-80 yrs. with PD, H&Y stage I-III. Excluded: MoCA≤17, inadequate functional status, major vestibular, visual, orthopaedic or muscular condition; medication changed n study period. | N = 40 Mean Age: 65 yrs. both groups. Mean H&Y: 2.5 (intervention); 2.4 (control), range I-III. | Home based balance exercises on DVD vs Therapist supervised balance exercises | Pre – post mean +/− SD, Home vs therapist groups Between group effect size | High | ||
Timed Up & Go | Duration Pre 22.96(+/−10.04), post 22.89 (+/− 10.58) [p = 0.83] vs pre 19.00 (+/−3.01), post 19.14(+/− 3.29) [p = 0.87] Between group treatment effect =0.99 | ||||||
Other reported outcomes: Functional Gait Analysis; Perceived balance confidence (ABC = Activity Specific Balance Confidence Scale); Intrinsic Motivation Inventory | |||||||
Collett, 2017 [18] UK | People with PD Excluded: Diagnosis of dementia or MMSE < 23, severe depression or psychosis | n = 105 Mean age 67 yrs. H&Y not reported | Self-managed exercise programme vs Self-managed handwriting exercises (control) | Measures listed: delta at 3 months, 6 months & 12 months, then effect size (d) for between groups, considering all 3 follow-up assessments. Small-moderate effect sizes = 0.1–0.3 | Some concerns | ||
Motor: 2 min walk | 3.8(+/− 3.5); 3.4 (+/− 3.5), 6.7 (+/− 3.6); d = 0.20 (− 0.44 to 0.45) | ||||||
Health & Wellbeing: EQ5D-5 L SF-36 | 1(+/− 3); 3(+/− 3); 2(+/− 3); d = 0.12 (− 0.12 to 0.36) Physical: 1(+/− 3); 1(+/− 3); 4(+/− 4); d = 0.10 (− 0.14 to 0.34) Mental: 1(+/− 3); 2(+/− 3); 2(+/− 14); d = 0.08 (− 0.16 to 0.32) | ||||||
Other reported outcomes: Other Motor Measures (MDS-UPDRS-III, 9-hole peg test for dexterity, Timed Up & Go); fitness (VO2, leg power, grip strength); non-motor symptoms (non-motor symptom questionnaire, Fatigue Severity Scale); Health status (BMI, BP, PASE) | |||||||
Collett, 2017 [17] UK As above: same study, different outcomes | As above | As above | Self-managed handwriting exercises vs Self-managed exercise programme (control) | Writing (amplitude measures) | [presented as above] Total area (mm2): − 6.0 (+/− 4.1), − 2.5 +/− 3.8, − 5.5 (+/− 4.2); d = 0.32 (− 0.11 to 0.74) % reduction in amplitude: − 10.4 (+/− 7.5), 6.0 (+/− 7.1), − 7.4 (+/− 8.8); d = 0.11 (− 0.31 to 0.53) | Some concerns | |
Other reported outcomes: Self-reported writing (MDS-UPDRS- item 2.7) | |||||||
Lakshminarayana 2017 [23] UK | People with PD Excluded: no/limited access to device or internet at home. Dementia or significant cognitive impairment. Major, serious comorbid illness. | n = 215 Mean age 60 yrs.; H&Y not reported | Parkinson’s Tracker App (PTA) vs Control: Treatment as Usual + telephone calls | GLM analysis: difference (95% CI) | High | ||
Medication Adherence (MMAS-8) | 0.39 (0.04, 0.74); p = 0.0304 [ANCOVA controlling for age, gender and comorbidity: 0.38 (0.03 to 0.73); p = 0.0301] | ||||||
QoL (PDQ − 39) | −0.22 (− 3.95, 3.52); p = 0.9102 | ||||||
Other reported outcomes: Quality of Consultations (PCQ-PD); Non-motor symptoms (NMS-Questionnaire, HADS); Beliefs about medication (Beliefs about Medication questionnaire) | |||||||
Sajatovic, 2017 [24] USA | People with PD and depression. Excluded those unable to walk or high falls risk; and MMSE < 24 | n = 30 Mean age 70 yrs.; H&Y range 1–3 | Group exercise + chronic disease self-management* vs Self-guided individual exercise + self-guided chronic disease self-management* | “No significant difference” between arms; data not given. Data pooled so results and analysis are pre/post intervention. | High | ||
Depression (MADRS) | Pre mean 21.2 (SD6.3); Post 12 weeks 15.2 (8.0) p < 0.001; 24 weeks 14.2 (8.5) p < 0.001 | ||||||
Other reported outcomes: Self-efficacy (GSE), Cognition (MoCA), Apathy (Apathy Scale), Anxiety (Covi Anxiety scale), Sleep (SCOPA-Sleep), Motor (MDS-UPDRS-III), satisfaction with intervention (custom). | |||||||
Advocat, 2016 [25] Australia | People with PD H&Y stage II, age 18-70 yrs., fluent in written & spoken English. | n = 72 Mean age 63 yrs. Mean H&Y 2 | ESSENCE mindfulness & self-management programme vs Waitlist Control | Note wait list controls received intervention after the 7 weeks so groups combined for 6 month outcomes. | 7 weeks: change intervention vs control. Effect size, d. | 6 months pre-post intervention and control; p for combined group. Effect size, d. | High |
Function & Wellbeing (PDQ39) | −0.54 (−3.41 to 2.32) vs −1.53 (3.64 to 0.57) ADL domain: − 2.43 (− 8.11 to 3.25) vs − 2.02 (− 4.66 to 0.62) p = 0.89 | −0.89 (− 3.71 to 1.93) and − 2.54 (− 6.76 to 1.67), p = 0.16. ADL domain: − 2.54 (− 6.7 to 1.8) and − 4.17 (− 10.75 to 2.42), p = 0.04 (d = 0.23, small) | |||||
Other reported outcomes: Mindfulness (FMI); Mood (Depression Anxiety Stress Scale); Exercise & nutrition (Health Behaviours Questionnaire) | |||||||
King, 2015 [26] USA | People with PD plus at least 1 comorbidity; age 40-80 yrs. Excluded moderate-severe cognitive impairment & those needing assistance with ADLs | N = 58 Mean age 64 yrs. Mean H&Y 2.4. | Sensorimotor-based Agility Boot Camp (exercise programme). 3 delivery methods compared: 1) Home exercise 2) Individual physical therapy 3) Group class | Different pre-post: mean; median (95% CI) for home vs individual vs class | Some concerns | ||
Physical Performance Test (PPT) | 0.71; 0.0 (−0.7, 2.2) p = 0.371 vs 1.81; 1.0 (0.69, 2.9) p = 0.004 vs 0.55; 0.5 (− 0.4, 1.5) p = 0.156. Group comparison: p = 0.265 Analysis of effect modifiers: Age p = 0.086 | ||||||
QoL: PDQ-39 | −6.65; −9.0, (− 11.6, − 1.7) p = 0.015 vs − 6.30; −5.5 (− 13.1, 0.5) p = 0.068 vs − 10.4; − 9.0 (− 16.8, − 4.0) p = 0.002 Group comparison: p = 0.448 Analysis of effect modifiers: Nil significant effects. | ||||||
UPDRS-II (ADL) | ADLs: − 0.65; − 1.0 (2.7, 1.4) p = 0.489 vs − 1.67; − 1.0 (− 2.9, − 4.3) p = 0.011 vs − 1.90; − 2.0 (− 4.0, − 2.0) p = 0.061 Group comparison: p = 0.691 Analysis of effect modifiers: UPDRS (p = 0.093) and comorbidity (p = 0.02) | ||||||
Other reported outcomes: Balance: Mini-BESTest; Mobility: TUG, Balance confidence: Activities-Specific Balance Confidence Scale; Apathy: Lille Apathy Rating Scale; UPDRS-III; Self-efficacy (Exercise Self-Efficacy Scale). Potential confounders measured and analysed: Comorbidities, UPDRS, Age, BMI, medication, MoCA, Depression. | |||||||
Lawson, 2013 [27] UK | People with PD and anxiety (HADS-A > 8) Excluded: age of PD onset ≤ 45 yrs; insufficient literacy (WTAR score ≤ 80), Cognitive impairment (ACE-R score ≤ 83). | n = 54 Mean age 66 yrs. Mean H&Y 2.4 | Bibliotherapy: “What? Me Worry!?!” online self-help guided resource vs Control: Information only + 1 telephone call | Mean (CI) paired pre-post difference for intervention vs control group. p values presented are for pre-post changes; no significant differences found between groups. | Some concerns | ||
Worry (PSWQ) | − 6.94 (− 13.52 to − 0.37), p < 0.05 vs 3.40 (0.52 to 6.28), p < 0.05 (note different direction of change) | ||||||
Health status (PDQ-39) | 1.0 (− 4.9 to 6.9) vs 2.86 (− 5.88 to 11.60), ns | ||||||
Other reported outcomes: Reactions to Uncertainty (IUS); Beliefs about worry (MCQ-30) | |||||||
A’Campo, 2010 [28] Netherlands | People with PD + carers. Excluded: severe psychiatric problems. | n = 64 (PD) + 46 (carers). Mean age 65 yrs. Mean H&Y 2.4 (intervention) & 2.3 (control) | Patient Education Program Parkinson (PEPP) vs Control: Usual Care (delayed intervention) | Mean difference between intervention arm change (pre-post) and control arm change (pre-post) (95%CI). Bonferoni adjusted significance level of < 0.01. | Some concerns | ||
Psychosocial impact of disease (BELA-P-k) | Patients Bothered by: 1.74 (− 1.27–4.74), p = 0.252; Need for help: 2.04 (− 2.0–6.06), p = 0.316 Carers Bothered by: 7.05 (2.96–11.14) p = 0.001; Need for help: 11.38 (5.36–17.40) p = 0.001 | ||||||
QoL (PDQ-39 for patients; EQ-5D for carers) | Patients 4.86 (0.98–8.73), p = 0.015 Carers Utilities − 0.10 (− 0.24–0.04) p = 0.159; VAS − 1.33 (− 11.33–8.66) p = 0.788 | ||||||
Other reported outcomes: Depression (Self-rated Depression Scale) | |||||||
aDereli, 2010 [29] Turkey | People with PD, H&Y stage I-III. Excluded: MMSE< 23, disease limiting the ability to perform the exercises, medication changed during study. | n = 32 Mean age 67 yrs. Mean H&Y 2 | Education + Physiotherapist-supervised exercise vs Education + Self-managed exercise at home. | Mean (SD) pre-post score difference for PT-led groups vs self-managed | Some concerns | ||
QoL (PDQLQ) | 11 (−2 to 23) vs 4 (−16 to 38), p = 0.040 | ||||||
Health status (NHP) | −10.5 (−33 to 0) vs −2 (− 13 to 40), p = 0.008 | ||||||
UPDRS-II | −3 (−7 to 0) vs −2 (−6 to − 2), p = 0.030 | ||||||
Other reported outcomes: PD severity (UPDRS); Depression (BDI) | |||||||
Tickle-Degnen, 2010 [30] USA | People age ≥ 40 yrs. with PD, H&Y stage II-III. Excluded: MMSE≤26, GDS ≥20, unable to walk without physical assistance, unable to understand and communicate with team, home beyond travel distance to site, medical condition impairing participation | n = 117 Mean age 66 yrs. H&Y range 2–3 | Self-management rehabilitation programme (2 intensity arms) vs Control: no rehabilitation (medical therapy only) | Quality of Life (PDQ39) | Summary Index adjusted mean (standard error) for 27 h group vs 18 h group vs control; intensity effect, eta (95% CI). eta = magnitude of the linear relationship between hours of rehabilitation outcome [interpreted as a product moment correlation (r) effect size.] Post intervention: 27.3 (1.1) vs 27.6 (1.1) vs 31.0 (1.1). eta 0.23 (0.05 to 0.40), p = 0.01 2 months follow-up: 28.4 (1.0) vs 28.5 (1.0) vs 30.6 (0.9). eta 0.16 (−0.02 to 0.34), p = 0.09 6 months follow-up: 28.2 (1.1) vs 29.2 (1.1) vs 31.5 (1.1). eta 0.21 (0.03 to 0.38), p = 0.02 ANCOVA: effect of intervention adjusted for baseline F(2,112) = 3.98, p = 0.02 Contrast analyses: outcomes co-vary with rehabilitation intensity (group): F(1,112) = 6.48, p = 0.01 primarily due to 0-18 h (p = 0.03) and 0-27 h (p = 0.02) comparisons, not 18-27 h (p = 0.89). Pooled rehab (18 h + 27 h) compared to control: difference 36% (CI 20–53%), p < 0.0001 | Some concerns | |
Grosset, 2007 [31] UK | People with PD Excluded: significant difficulties using pill bottle. | n = 83 Mean age 64 yrs.; Mean H&Y 2.4 | Educational: Verbal & written information vs Control: Usual Care | Intervention arm change (pre-post) vs Control arm change (pre-post) | High | ||
Medication adherence (MEMS® electronic pill bottles timing adherence) | Median % + 22% vs − 1%, p = 0.007 | ||||||
QoL (PDQ-SI) | + 6 vs + 1.5, p = ns | ||||||
Function (S&E) | −7 vs −3, p = ns | ||||||
Other reported outcomes: Motor (UPDRS-III) | |||||||
Pearl-Kraus, 2007 [32] USA | People age 30-79 yrs. with PD H&Y stage II-III, able to speak & write in English, able to attend. Excluded: diagnosed cognitive impairment or MMSE < 23, significant hearing loss, education less than 9th grade. | N = 48 Mean age 68 yrs. H&Y not given | “PD-Collaborative Care” education programme with self-management vs active control: “PD Information Transfer” (education) | Pre, post, mean (+/−SD) Intervention vs control. Repeated measures ANOVA to analyse. | Low | ||
Quality of Life (PDQ-39) | Pre 24.6 (+/−16.1), post 25.7 (+/− 16.6), 4 weeks 28.0(+/−17.3) vs pre 29.9 (+/− 16.2), post 31.9 (13.4), 4 weeks 28.8(+/−14.6) Pre-post: Group interaction p = 0.40, time interaction p = 0.31 Post-4 weeks: Group interaction p = 0.89, time p = 0.12 | ||||||
Other reported outcomes: Self-efficacy for managing chronic disease (6-item scale) | |||||||
Montgomery 1994 [33] USA | People with PD who had applied to enrol on the Propath program. | N = 322 Mean age: 68.1 yrs. (intervention); 70.6 yrs. (control) H&Y not given. | Patient education & health promotion vs Waitlist control | Mean change in score (SE) at 6 months for intervention vs control; p* = between group | High | ||
Questionnaire incorporating questions from UPDRS | Summary score: 0.11 (0.74) [p = 0.89] vs 29.7 (0.75) [p = 0.0001] P* = 0.007 Patient global assessment: − 0.57 (1.58) [p = 0.72] vs 2.92 (1.62) [p = 0.075] P* = 0.12 | ||||||
Assessment differences in final observations: mean+/−SE; intervention vs control | |||||||
‘Quality of life’ questionnaire | Patient Global assessment: 41.0 (1.8) vs 43.5 (2.0). Self-efficacy (total): 904.0 (24.0) [p < 0.01] vs 795.0 (22.0) Spouse stress: 35.0 (1.8) vs 38.2 (1.8) Spouse assessment of participant: 12.1 (0.6) vs 11.3 (0.5) | ||||||
Other reported outcomes: Exercise, medication use, health service utilization. | |||||||
Randomised Controlled Trial (Crossover) | |||||||
McNaney, 2019 [34] UK | People with PD H&Y stage I-III with acknowledged daytime drooling problem, able to understand instructions. Excluded: current pharmacological treatment for drooling; insufficient dexterity to use device. | n = 27 Median age: 72 yrs. (Immediate) & 75 yrs. (Delayed) H&Y: range II-IV, mean 2.68. | Cueing device for drooling vs Delayed intervention. Treatment as usual in the waiting period. | Pre-post for Immediate Intervention vs Pre-post for Delayed Intervention; Median (IQR) Mann-Whitney U test & Significance of between group difference | High | ||
ROMP-Saliva | Pre 22 (16–23), post 22 (17–25.5) vs Pre 20 (17–25), post 19 (17–30) U = 83, z = 0.497, p = 0.619 | ||||||
Other reported outcomes: MDS-UPDRS question 2.2; Drooling diary (VAS): Severity, Duration & Frequency | |||||||
Non-randomised Controlled Trials | |||||||
Hellqvist, 2020 [35] Sweden | People with PD & care partners. Excluded: cognitive impairment affecting their ability to understand & respond to outcome measures. | n = 92 (PD) + 55 (carer) Mean age, PD: 71 yrs. (intervention), 68 yrs. (control) Mean age carer: 72 yrs. (intervention), 69 yrs. (control). H&Y median 3 (range 1–4) for intervention arm. | Swedish National Parkinson School (NPS) vs matched control: standard care | Median (IQR) pre and post for intervention vs control. Mann–Whitney U test for comparisons between groups. Wilcoxon’s signed rank test for within group comparisons. | Mod | ||
QoL (PDQ-8 for participants with PD) | Pre 28.1 (17.2–39.1), post 23.4 (14.8–37.5) [p = −0.028] vs pre 25 (12.5–37.5), post 23.4 (13.3–37.5) [p = 0.644] Between group difference: baseline p = 0.301, post p = 0.713 | ||||||
Zarit Burden Interview –short form (care partners) | Pre 7 (3–13), post 8 (3.25–12.75) [p = 0.090] vs pre 6 (0.7–12.5), post 5 (2–13.25) [p = 0.548]. Between group difference: baseline p = 0.495, post p = 0.659 | ||||||
Health status (EQ-5D) | Pre 0.87 (0.71–0.93), post 0.88 (0.78–0.93) [p = 0.023] vs pre 0.86 (0.79–0.93), post 0.86 (0.79–0.91) [p = 0.866]. Between group difference: baseline p = 0.473, post p = 0.279 | ||||||
Life Satisfaction (LiSat-11) | “Life as a whole” score: Pre 4 (3–5), post 4.5 (4–5) [p = 0.17] vs pre 5 (4–5), post 4.5 (4–5), [p = 0.011] Between group difference: baseline p = 0.031, post p = 0.868 | ||||||
Outcomes but follow-up results not reported: Perceived general health (item 1 of the RAND-36) & Function (PADLS). Other reported outcomes: Fatigue (PFS-16) Efficacy of self-management education (heiQ) | |||||||
Lyons, 2020 [36] USA | People with PD & co-residing partner for ≥1 yr, both willing to enrol. Able to provide informed consent. Marketed to early PD but later stages not excluded. | n = 39 (PD) + 39 (partners) Age, PD: 71 yrs. intervention& 66 yrs. control Age, partners: 68 yrs. intervention & 66 yrs. control. H&Y not given. | “Strive to Thrive” Dyad Self-management programme vs Waitlist control | Mean (Standard deviation): change in intervention group vs control group; group difference controlling for baseline outcome and age. Cohen’s d [0.2 ~ small, 0.5 ~ medium, 0.8 ~ large]. | Mod | ||
SF-36, Physical Health score | PD: −0.28 (4.69) vs 0.34 (6.33). Group diff −2.50; d = 0.31 (greater decline in intervention group) Spouses: − 0.86 (5.22) vs − 1.46 (6.27). Group diff − 0.22; d = 0.02 | ||||||
SF-36, Depressive Symptoms score | PD: −0.26 (5.20) vs 0.22 (6.09). Group diff − 0.82; d = 0.14 Spouses: − 0.59 (2.90) vs 2.19 (5.68). Group diff − 1.74; d = 0.29. | ||||||
Multidimensional Caregiver Strain Index (MCSI) | −0.88 (3.18) vs − 0.45 (2.72) Group diff: − 0.75; d = 0.15 | ||||||
Other reported outcomes: Measures of self-management behaviours and self-efficacy; Confidence to self-manage (participant and spouse); CES-D scale [Centre for Epidemiologic Studies – Depression Scale]; aerobic activity; Strength based exercise; Mental Relaxation, Illness communication | |||||||
Pappa, 2017 [37] USA | People with PD H&Y stage I-III (+carers, but not analysed) Excluded: suspected dementia or MMSE < 25, psychotic disorder, practical issues limiting participation (e.g. lack of transport, non-English speaking).Controls = eligible for study but unable to participate in workshop due to personal circumstances. | N = 46 [+ 6 carers – not in quant analysis] Mean age 68 yrs. Mean H&Y 2.2, range 1–3 | Stanford Chronic Disease Self-Management Programme (CDSMP) vs Control: usual care. | Pre, post Intervention vs Pre, post Control, mean (SD) | Mod | ||
Social Support (ISEL) | Pre 77.8 (5.3), Post 78.4 (5.7) vs Pre 76.6 (4.5) Post 78.2 (4.9) Fs ≤ 1.19, ps ≥ 0.28 | ||||||
Other outcome measures given as correlates of ISEL for the intervention group, [outcome results not presented]: Self-Efficacy (CDSES); Health status (PDQ-39); Home, community, socioeconomic & social participation and empowerment (CPI, Involvement in Life Situations Scale, Control over Participation Scale) | |||||||
Lun, 2005 [38] Canada | People with PD H&Y stage II-III. Excluded: unstable medication condition, other balance disorder, current regular exercise, health contraindication to exercise, dementia. | n = 19 Mean 65 yrs. Mean H&Y 2 | Self-managed exercise vs Control: Physiotherapist-supervised exercise | Mean (CI) change pre-post intervention | High | ||
Motor features (UPDRS-III) | Intervention (home) vs control (physio) group UPDRSm: −5 [p < 0.022] vs −5 [p < 0.009] Groups pooled for 16 week results: ‘continued exercise’ (CE) vs ‘discontinued’ (DE): UPDRSm: pre 24 (sd = 8), post 15 (sd = 9) vs pre 17 (sd = 5), post 13 (sd = 4) | ||||||
Other reported outcomes: BBS, TUG, full UPDRS, ABC | |||||||
Lindskov, 2007 [39] Sweden | People with PD. Excluded significant cognitive impairment. | n = 48 Mean age: 69 yrs. (intervention), 72 yrs. (control) Median H&Y (range): I (I-III) (intervention) I (I-IV) (control) | Multidisciplinary Education Programme vs Delayed intervention control | Difference (pre-post) in intervention group vs difference in control group, Mean (95% confidence interval) Between group differences evaluated by Mann-Whitney U-Test | Mod | ||
SF-12 Physical component summary score Mental component summary score | 1. (−1.8, 5.8) vs 1.5 (−2, 5.0); p = 0.393 2.5 (− 1.0, 5.9) vs 1.1 (− 2.4, 4.6); p = 0.361 | ||||||
Other reported outcomes: Levodopa Equivalents | |||||||
Non-Randomised Non-Controlled: Pre/Post Intervention Designs | |||||||
Li, 2020 [40] Australia | People > 21 yrs. with PD, H&Y stage I-III, comprehend English, live in area & able to attend. Excluded: medically unwell, significant neuropsychiatric disorder (inc cognitive impairment) that precludes consent or participation; unable to mobilize with assistance or did not have a carer to assist if they required assistance. | n = 152 Mean age 71 yrs. Mean H&Y = 1.6 (54% = H&Y 1) | PD-Wellbeing programme: Education & Exercise | Pre, post and 1 year follow-up results. | Mod | ||
Exercise behaviour | Note post-intervention not assessed due to the programme impact on exercise activity. “Exercisers”: Pre: 16%, 1 yr:44% (p < 0.001) Exercise less than recommended: Pre: 36%, 1 yr:36% No exercise: Pre: 48%, 1 yr: 19% | ||||||
Other reported outcomes: Depression Anxiety and Stress Scale-21 (DASS-21). Univariate analysis for baseline factors and the exercise behaviour outcome performed. | |||||||
Mestre, 2020 [41] Canada | People with PD plus care partners. 2 recruitment groups: Newly diagnosed (< 1 yr) and advanced (diagnosis > 8 yrs. or H&Y stage ≥III) | n = 100 Newly diagnosed group mean age 69.4 yrs. Advanced group mean age 67.3 yrs. H&Y not given | Integrated Care Network | Difference from baseline (95% confidence interval) | Mod | ||
Parkinson’s Disease Questionnaire–8 (PDQ-8) | 3 months: 1.9 (−0.4 to 4.3); p = 0.08 6 months 2.7 (0.4 to 5.0); p = 0.02 | ||||||
MDS-UPDRS: Part II | 3 months: 0.3 (−0.6 to 1.2); p = 0.49 6 months: − 0.02 (− 0.9 to 0.9); p = 0.97 | ||||||
Zarit Caregiver Burden Questionnaire. | 3 months: 0 (−1.5 to 1.4); p = 0.96 6 months: 0.7 (−0.7 to 2.2); p = 0.30 | ||||||
Perception of support: Patient Assessment of Chronic Illness Case+ (PACIC+) | 3 months: 1 (0.9 to 1.2); p < 0.0001 6 months: 1.1 (0.9 to 1.4), p < 0.0001 | ||||||
Other reported outcomes: Self-management (5As); MDS-UPDRS (parts I & III); Geriatric Depression Score; Program satisfaction (Likert type scale); cost analysis. Clinical Global Impression scales – data not presented. | |||||||
Horne, 2019 [42] Australia Overlap with Li et al study sample above | People > 21 yrs. with PD, H&Y stage I-III, comprehend English, live in area & able to attend. Excluded: medically unwell, significant neuropsychiatric disorder (inc cognitive impairment) that precludes consent or participation; unable to mobilize with assistance or did not have a carer to assist if they required assistance. | n = 135 Mean age 71 yrs. Mean H&Y = 1.7 (+/− 0.8) | PD-Wellbeing programme: Education & Exercise | Pre, post (at 6 weeks) and 1 year follow-up results: mean (SD) | Mod | ||
Physical measures: 2-min walk distance (m) Sit-to-stand (no. in 30s) Timed Up & Go (seconds) Gait velocity (m/s) Berg Balance Scale | Pre 131.9 (41.8), post 151.9 (34.40), [p = 0.001]; 12 month (149.5) [p = 0.001] Pre 12.49 (3.95), post 15.61 (4.25) [p = 0.001]; 12 months 14.88 (4.11) [p = 0.001] Pre 10.12 (9.40), post 7.63 (2.91) [p = 0.001]; 12 months 7.99 (2.89); [p = 0.001] Pre 1.54 (0.44), post 1.74 (0.43), [p = 0.001]; 12 months 1.72 (0.43), [p = 0.001] Pre 52.2 (7.90), post 54.4 (4.40) [p = 0.001], 12 month 54.5 (3.20) [p = 0.001] | ||||||
PDQ-39 | Pre 34.41 (24.95), post 28.17 (21.82), [p = 0.001]; 12 months 29.46 (21.60) [p = 0.1] | ||||||
Other reported outcomes: DASS-21, PFS-16 | |||||||
Van Wegen, 2018 [43] Netherlands | People with PD H&Y stage I-III, stooped posture (UPDRS item 28 scores ≥2) that can be actively corrected. Excluded: insufficient cognitive function, relevant comorbidity. | n = 15 Mean age 70 yrs.; H&Y not given | “UpRight” posture detection device with feedback [device inactive but monitoring for pre- phase] | Posture (Trunk angle measured by device) | Mean (SD) Pre 12.9 (5.9); post 7.5 (5.0); mean change = −5.4 (4.3); p < 0.01 | Mod | |
Other reported outcomes: Satisfaction (custom survey including a VAS); Adverse event (log) | |||||||
Hermanns, 2017 [44] USA | People age ≥ 65 yrs. with PD H&Y stage I-IV, able to speak & read English, ambulatory, with written physician approval to engage in the exercise program. Excluded: no access to internet; inability to perform large muscle movements, cognitive impairments that prohibit participation. | n = 5 Mean age 73 yrs. H&Y mean 1.7 (range 1–2.5) | Digital Physical Activity Tracker & Online Support Group | PAAI (Physical Activity Assessment Inventory) | Pre 4585, post 2620: % change −42.86 | Mod | |
Functional Assessment of Cancer Therapy-General (FACT-G) | Pre 440, post 426: % change = −3.18 | ||||||
Other reported outcomes: Feasibility (useage) | |||||||
Esculier 2012 [45] Canada | People with PD; [healthy people without PD] MMSE≥24, any comorbidity or limb condition, history of falls. | N = 11 [healthy: n = 9] Mean age 62 yrs. H&Y not given | Home based balance training [study compared to paired sample of “healthy” participants – not relevant here] | Difference (pre-post), median | Low | ||
Balance: ABC | + 1 (ns) | ||||||
Mobility: TUG STST Tinetti’s POMA Community Balance & Mobility Scale 10 m walking speed | −1.9 (p < 0.04) + 5 (p < 0.01) + 4.0 (p < 0.05) + 15.0 (p < 0.02) −0.7 time to complete (p < 0.001) | ||||||
Other reported outcomes: Static balance: 1-leg stance duration; programme specific evaluation (likert-type scale) | |||||||
Nelson, 2011 [46] USA | Veterans with PD H&Y stage II-III plus spouses with ≥1 chronic medical condition. Excluded: cognitive impairment (MMSE ≤24); depression (CES-D score ≥ 12). Excluded spouses with dementia or depression. | n = 13 (PD) + 7 (spouses); Mean age 74 yrs. Mean H&Y 2.5 (2–3) | Stanford Chronic Disease Self-Management Programme (CDSMP) | Quality of Life (PDQ-8) | Pre 30.97, Post 6 weeks 24.12, 6 months 27.70; p = ns | Mod | |
Self-rated health status | Pre 2.63, Post 6 weeks 2.89, 6 months 2.50; p = ns | ||||||
Other reported outcomes: Self-efficacy (SPERC self-efficacy scale); Exercise (SPERC exercise behaviour scale); Pain & Fatigue (SPERC VNS); Depression (CES-D) | |||||||
Gruber 2008 [47] Canada | People with PD diagnosed within the last 3 yrs. and H&Y stage 1 or 2. | N = 92 Mean age: 52.4 yrs. (site 1) 62.6 yrs. (site 2) H&Y: 97% stages I-II; stage III n = 1 (site 1) 96% stages I-II; stage III n = 3 (site 2). | Early Management Program (self-management, focussed on exercise) | Pre; post mean (SD) | Mod | ||
CISM = Chronic Illness Self-Management Questionnaire | Exercise: stretching and/or strengthening: 61.4 (64.2); 91.1 (59.9), p ≤ 0.001 Exercise: aerobic: 1. (143.3); 145.9 (140.5), p = not significant Cognitive symptom management: 1.0 (0.9); 1.5 (0.9); p ≤ 0.001 Mental stress management/relaxation: 1. (0.5); 1.5 (0.6), p ≤ 0.01 Communication with physician: 2.0 (1.5); 3.1 (1.3), p ≤ 0.05 | ||||||
Other reported outcomes: Functional Reach; times functional movements; walking speed; Functional Axial Rotation | |||||||
Macht, 2007 [48] 7 European countries | People with PD | n = 151 Mean 64 yrs.; H&Y mean 2, range 1–5 | Patient Education Program Parkinson (PEPP) | Feasibility (intervention evaluation questionnaire) | Range 35–80% average agreement with positive statements and 34–71% average agreement with negative statements. | Mod | |
QoL (PDQ-39) | Pre mean 30.8 (SD 16.2); Post 30.7 (7.7); p = ns | ||||||
Psychosocial impact of PD (BELA-P-k) | Pre mean 26.7 (SD 15.6); Post 21.0 (14.7); p < 0.001 | ||||||
Other reported outcomes: Depression (SDS); Mood (VAS) | |||||||
Simons, 2006 Same as Macht above but UK sample [49] UK | People with PD. Excluded ‘possible cognitive decline’ based on MMSE≤21. | n = 36 H&Y 1–4 | Patient Education Program: “EduPark” (same as PEPP) | Feasibility (intervention evaluation questionnaire) | Range 40–100% average agreement with positive statements and 0–40% average agreement with negative statements. | Mod | |
QoL (PDQ-39) | Data not given. No significant differences were found. | ||||||
Psychosocial impact of PD (BELA-P-k) | Data not given. No significant differences were found. | ||||||
Other reported outcomes: Mood (VAS) | |||||||
Sunvisson, 2001 [50] Sweden | People with PD H&Y stage I-IV, able to walk independently. | n = 43 Mean age 75 yrs. Mean H&Y 1.84 | Education programme (information & physical) | Mean (SD) pre, post. | Mod | ||
UPDRS-II | ADL: 9.48 (5.646), post 9.35 (5.524), [difference 0.140] p = 0.7532; 17 weeks post 8.21 (5.655) [difference 1.429] p = 0.0098. | ||||||
Sickness impact profile (SIP) | Pre 11.99 (1.23), post 1.41 (9.52); p = 0.0341 | ||||||
Other reported outcomes: UPDRS-III; Postural Locomotor Manual (PLM) test. | |||||||
Jordan, 1993 [51] Australia | Nursing home residents with communication impairments, subgroup presented for those with PD. Coexisting medical problems not excluded. | n = 4; Mean age 79 yrs. H&Y not reported | Group communication therapy with self-management strategies | Mean (SD), no p values given | Mod | ||
Conversation analysis (PCI = Profile of Communicative Interactions) | % Attempted ‘repairs’: Sample 1: pre 89 (11), post 100 (0) Sample 2: pre 100 (0), post 95 (5) % successful repairs: Sample 1: pre 93 (7), post 91.5 (8.5) Sample 2: pre 97 (3), post 100 (0) | ||||||
Other reported outcomes: Communication effectiveness (CETI); change of knowledge (custom test) | |||||||