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Importance: It is unclear whether physiotherapy and occupational therapy are clinically effective and cost-effective in Parkinson disease (PD).
Objective: To perform a large pragmatic randomized clinical trial to evaluate the clinical effectiveness of individualized physiotherapy and occupational therapy in PD.
Design, Setting, And Participants: The PD REHAB Trial was a multicenter, open-label, parallel group, controlled efficacy trial. A total of 762 patients with mild to moderate PD were recruited from 38 sites across the United Kingdom. Recruitment took place between October 2009 and June 2012, with 15 months of follow-up.
Interventions: Participants with limitations in activities of daily living (ADL) were randomized to physiotherapy and occupational therapy or no therapy.
Main Outcomes And Measures: The primary outcome was the Nottingham Extended Activities of Daily Living (NEADL) Scale score at 3 months after randomization. Secondary outcomes were health-related quality of life (assessed by Parkinson Disease Questionnaire-39 and EuroQol-5D); adverse events; and caregiver quality of life. Outcomes were assessed before trial entry and then 3, 9, and 15 months after randomization.
Results: Of the 762 patients included in the study (mean [SD] age, 70 [9.1] years), 381 received physiotherapy and occupational therapy and 381 received no therapy. At 3 months, there was no difference between groups in NEADL total score (difference, 0.5 points; 95% CI, -0.7 to 1.7; P = .41) or Parkinson Disease Questionnaire-39 summary index (0.007 points; 95% CI, -1.5 to 1.5; P = .99). The EuroQol-5D quotient was of borderline significance in favor of therapy (-0.03; 95% CI, -0.07 to -0.002; P = .04). The median therapist contact time was 4 visits of 58 minutes over 8 weeks. Repeated-measures analysis showed no difference in NEADL total score, but Parkinson Disease Questionnaire-39 summary index (diverging 1.6 points per annum; 95% CI, 0.47 to 2.62; P = .005) and EuroQol-5D score (0.02; 95% CI, 0.00007 to 0.03; P = .04) showed small differences in favor of therapy. There was no difference in adverse events.
Conclusions And Relevance: Physiotherapy and occupational therapy were not associated with immediate or medium-term clinically meaningful improvements in ADL or quality of life in mild to moderate PD. This evidence does not support the use of low-dose, patient-centered, goal-directed physiotherapy and occupational therapy in patients in the early stages of PD. Future research should explore the development and testing of more structured and intensive physical and occupational therapy programs in patients with all stages of PD.
Trial Registration: isrctn.org Identifier: ISRCTN17452402.
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http://dx.doi.org/10.1001/jamaneurol.2015.4452 | DOI Listing |
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A distinction between infections of left ventricular assist devices (LVADs) and cardiac implantable electronic devices (CIEDs) is warranted as they differ markedly in incidence, microbiologic profiles, clinical presentations, and extraction feasibility. These differences necessitate tailored suppressive antibiotic therapy (SAT) strategies. This commentary highlights the need for device-specific SAT approaches.
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Department of International Affairs and Social Sciences, College of Humanities and Social Sciences, Zayed University, Abu Dhabi, United Arab Emirates.
The Israel military occupation, ongoing for over 75 years, has profoundly impacted the health and well-being of Palestinians. Despite longstanding calls for Universal Health Coverage (UHC) and sustainable development, the response of global health systems and organizations to crises such as the recent large-scale military assault on Gaza in October 2023 has been inadequate. There is a critical need to examine why these global health approaches have failed and how they can be restructured to address the unique challenges in Gaza effectively.
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December 2024
University of Montreal, Canada.
This scoping review aimed to map the various facets of intuition in occupational therapy (OT), from its definitions, theoretical frameworks, epistemological paradigms to practical applications, highlighting its role in decision-making. Following the Joanna Briggs Institute methodology, a systematic search of five databases from 1990 to August 2023 identified 337 records related to OT and intuition. After removing duplicates and applying eligibility criteria, 22 studies were included.
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December 2024
Tel Aviv University, Israel.
Attention deficit/hyperactivity disorder (ADHD) is characterized by inattention, hyperactivity, and impulsivity, as children may present developmental and chronic impairments in cognitive-emotional and sensory-motor aspects. This study examined the changes in self-efficacy, muscle tone, and mood following a single session of Equine-Assisted Occupational Therapy (EAOT) within Attention Skills Therapy (ASTride) intervention, designed to improve emotional and cognitive functions. Notably, 31 children diagnosed with ADHD aged 6-12 (mean age 10.
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