Occupational therapy for people with Parkinson's disease: towards evidence-informed care

Abstract

Parkinson’s disease progressively hampers daily activities and participation. As part of the multidisciplinary team, occupational therapists aim to enhance daily functioning of the person with Parkinson’s disease by strengthening the person’s capacity in activity performance and participation, and by adapting daily routines or the environmental context. Solutions are sought in partnership with the person with Parkinson’s and his or her caregiver. However, worldwide there was a lack of evidence for occupational therapy in Parkinson’s disease. This thesis presents a systematic evaluation of an individualized and home-based occupational therapy intervention for people with Parkinson’s and their caregivers (the OTiP intervention). First we explored the intervention and study design in a feasibility study. Subsequently, we tested efficacy and cost-effectiveness of the OTiP intervention compared to usual care (no occupational therapy). Alongside the trial we performed a process evaluation of the intervention, covering intervention delivery and experiences. The main randomized controlled trial showed that the intervention was effective in improving perceived daily functioning of Parkinson’s patients at 3 months and at 6 months follow-up. In the economic evaluation no significant differences in total costs were found between the intervention and control groups. However, institutional health care costs were significantly lower for the intervention group. Finally, the process evaluation demonstrated the complexity of interacting factors affecting treatment delivery and benefits of the intervention. The results of the research provide insights for further improving individualized healthcare for people with Parkinson’s and their caregivers.