Multidimensional Rehab Program Found to Improve Functional, Cognitive Disability in Parkinson Disease

A multidisciplinary rehabilitation program may provide functional and cognitive improvement in people with mild to moderate Parkinson disease (PD), according to study findings published in Frontiers in Neurology.

PD is a clinically heterogeneous condition characterized by motor (resting tremor, rigidity, bradykinesia) and nonmotor (cognitive, neuropsychiatric, and autonomic problems) symptom fluctuations, so patients can present with substantially different disease courses that can affect the efficacy of otherwise recommended antiparkinsonian therapies such as levodopa.

Moreover, the severity of PD is known to increase with time, as the occurrence of OFF periods, which are associated with significant economic burden and productivity of employment, has been indicated to affect 70% of patients within 9 years of using levodopa, compared with 40% within 4 to 5 years after diagnosis.

Previous studies have shown that a multidisciplinary care team approach may help to address the wide array of symptoms associated with PD, ranging from behavioral health and occupational considerations to on-time administration of therapies.

Researchers of the present study sought to further explore the short-term effects that a multidisciplinary rehabilitation program may provide to patients with PD in functional, cognitive, and geriatric domains.

Classifying disease severity by the Unified Parkinson’s Disease Rating Scale III (UPDRS-III), researchers compared the effects of a rehab program characterized by cognitive, physical, occupational, and speech therapies between patients with mild-moderate (UPDRS-III ≤ 59) and severe (UPDRS-III > 59)stages of the disease.

In the retrospective, observational study, 24 patients with PD (mean [SD] age, 76.25 [9.42] years; 58% female; median [interquartile range] Hoehn and Yahr stage, 4.00 [1.75]) in mild-moderate to severe stages were evaluated for motor, cognitive, functional, and neuropsychiatric aspects at baseline and discharge.

Each participant was involved in the person-tailored, inpatient, intensive (5–7 days per week), multidisciplinary, comprehensive, and rehabilitative program.

“The primary aim of the rehabilitation program was to increase and promote functional, motor, and cognitive abilities, as well as to optimize the subjects’ medication regimens,” added the study authors.

In their findings, 87.5% of the study cohort reported significant reduction of functional disability based on the Barthel Index (P < .001). Furthermore, significant improvements were observed for the Token test (p = 0.021), semantic fluency (P = .036), Rey’s Figure-Copy (P < .001), and Raven’s Colored Progressive Matrices (P = .004).

Improvements were also found in pain intensity perception via Numeric Rating Scale (P < .001) and the risk of developing pressure ulcers via the Norton Scale (P < .001).

When comparing patients with mild-moderate and severe disease stages, those in the mild-moderate group showed a positive correlation between the number of neuromotor sessions and the change in functional disability and language comprehension. Conversely, patients of the severe disease group reported a higher number of hospitalization days, although the total number of completed sessions was positively associated with changes in visuoconstructional abilities.

“Our findings suggest that an intensive, inpatient, and multidisciplinary rehabilitation program may improve functional abilities, some strategic cognitive functions, and geriatric aspects in patients with PD with mild–moderate motor impairment,” concluded the study authors.

Reference

Meloni M, Saibene FL, Tella SD, et al. Functional and cognitive improvement after an intensive inpatient multidisciplinary rehabilitation program in mild to severe Parkinson's disease: a retrospective and observational study. Front Neurol. Published online March 18, 2021. doi:10.3389/fneur.2021.626041