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Parkinson's disease is a progressive neurodegenerative condition affecting 145,500 people in the UK. The condition impairs movement leading to gait and dexterity problems. Various types of exercise are beneficial for both motor and non-motor symptoms such as depression.
The World Health Organisation's (WHO) recommendations on exercise include at least 150 minutes of moderate-intensity aerobic physical activity per week . People with Parkinson's may struggle to achieve this because of movement problems and fatigue. Physiotherapists may have a role in persuading people to exercise and supporting them in their activity goals. While studies show that Parkinson's patients with falls or gait freezing clearly benefit form physiotherapy, there is at present no robust evidence to demonstrate the impact of physiotherapy early in the course of the illness.
PEEP seeks to explore the effectiveness of physiotherapy for early Parkinson's (ie within 4 years of diagnosis and before onset of falls).
It comprises three distinct parts:
Staff and some participants involved in the fRCT will be included in a qualitative process evaluation to assess the acceptability and feasibility of the intervention and the research assessments.
The Principle research question is:
The project has 3 elements:
Survey of people with Parkinson's:
Online and paper survey will be available for people with Parkinson's to complete. The survey will be posted on the Parkinson's UK website. The survey will be open to UK residents with Parkinson's who have been diagnosed within the last 4 years.
Feasibility Randomised Controlled Trial The project will also consist of a Feasibility trial of physiotherapy for early Parkinson's versus usual care. Randomised controlled trial. Blinded assessment of outcomes. Parallel group design. Patient will be followed up at 3 and 6 months after the baseline visit. The RCT will be set in two NHS tertiary care centres.
At baseline, the following study procedures will be completed. Eligibity assessment by the PI or delegated research team member. 1. Demographics, medical history, medication history, physical examination (DOB, Height, Weight, Sex) The following Standard Questionnaires will be completed at the baseline visit.
Activity monitors: The research nurse will provide each participant with a activity monitor and provide instruction on how to use and charge at home. The monitor will be provided fully charged. The device will be worn on the wrist. Participants will be asked to wear the device for the next 7 days. The device can be worn while showering or swimming. The device should then be returned to the research team in a stamped addressed envelope provided, along with the completed activity diary. The main outcomes of interest from the activity monitors will be average daily step count and active minutes/day.
For Participants randomised to the intervention arm, they will attend an initial assessment visit followed by 4 physiotherapy intervention visits. At each of these 5 visits, a checklist will be completed by the physiotherapist to document what has been delivered as part of the intervention.
The following assessments will take place at 3 months and 6 months after baseline visit.
Qualitative Process evaluation.
Both staff and participants will be interviewed to explore views on care and the intervention. Interviews will last roughly 1 hour. Interviews will include:
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Comparison | No Intervention | In this arm participants will attend 3 study visits to complete study questionnaire and assessments. In between these visits, participants will be asked to wear an activity monitor and record an activity diary for one week. Other than this, participants will continue to receive only standard of care treatment. | |
| Intervention arm | Experimental | In this arm participants will attend the same 3 study visits to complete study questionnaires and assessments. Participants will be asked to wear an acitvity monitor and record an activity diary for one week after the study visits. In between baseline and 6 month follow up, intervention arm participants will receive study physiotherapy. This will consist of an individual assessment and 4 additional sessions of physiotherapy. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Physiotherapy Intervention | Other | Physiotherapy intervention will include an assessment to identify individual areas that physiotherapy should target. Intervention will be based on the core areas recommended by the European Physiotherapy Guideline for Parkinson's Disease: physical capacity (muscle power, tone, joint range of movement, exercise tolerance and pain), transfers, manual dexterity, balance and gait. Posture is incorporated as part of these 5 core areas. The intervention will be delivered over 4 visits. |
| Measure | Description | Time Frame |
|---|---|---|
| Number of Eligible Patients | Screening data will be collected to understand how many participants are eligible for the study. This data is a feasibility outcome which will be used to determine if a larger scale definitive study is possible. The data collected surrounding number of eligible patients can help to power in any future study. | Collected up to 104 weeks. |
| Length of waiting time from enrolment to delivery of intervention. | Measurement of time between consent and the completion of the physiotherapy intervention. This will be considered a feasibility outcome to determine whether the intervention is feasible for a larger definitive study. | Collected up to 130 weeks. |
| Change from baseline to follow up time points for all clinical outcomes | The change in all clinical outcomes from baseline to 6 months, the standard deviation, and the effect size of clinical outcomes to define the primary outcome for a future definitive trial. | Collected up to 130 weeks. |
| Completeness of data collection for clinical outcomes. | Percentage of data completeness will be collected as a feasibility outcome to determine if clinical outcomes can be used in a definitive study | Collected up to 130 weeks. |
| Adherence of clinical staff to intervention protocol. | This outcome will assess whether the planned number of physiotherapy treatment sessions (4) and follow up telephone consultations (2) are undertaken. A bespoke checklist will be used to document each phone call and physiotherapy visit to outline that the intervention has been delivered. | Collected up to 130 weeks |
| Whether the person assessing the clinical outcomes at baseline, 3 month and 6 month outcomes is blinded |
| Measure | Description | Time Frame |
|---|---|---|
| Parkinson's Disease Questionnaire 39 (PDQ-39) | Clinical Outcome collected by Questionnaire. Scored 0-100, 100 is considered the worst outcome. | Collected at Baseline, 3 and 6 month follow up |
| Unified Parkinson's Disease Rating Scale (UPDRS) |
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INCLUSION CRITERIA Survey of people with Parkinson's
Feasibility RCT
Qualitative process evaluation
EXCLUSION CRITERIA
OP physiotherapy for trauma or arthritis will not be exclusion A single one -off assessment of Parkinson's by a physiotherapist will not be an exclusion Attendance at exercise classes which are not supervised by a physiotherapist will not count as an exclusion.
IP physiotherapy will not count as an exclusion Unable to communicate in English
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Daniel Davis | Contact | 01332 724736 | 24736 | daniel.davis6@nhs.net |
| Rob Skelly | Contact | rob.skelly@nhs.net |
| Name | Affiliation | Role |
|---|---|---|
| Robert Skelly | University Hospitals of Derby and Burton NHS Foundation Trust | Principal Investigator |
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| ID | Term |
|---|---|
| D010300 | Parkinson Disease |
| ID | Term |
|---|---|
| D020734 | Parkinsonian Disorders |
| D001480 | Basal Ganglia Diseases |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
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|
This will be self reported by the clinician to indicate if the blind was broken. This will be used as a feasibility outcome to determine if any future definitive study can be blinded |
| Collected up to 130 weeks. |
| Feasibility of Using Activity Monitor | • Practicalities (including time taken to retrieve and record data) of using commercially available activity monitors as an outcome measure. | Collected up to 130 weeks. |
| Feasibility and Acceptability of Study Intervention through Qualitative interviews with staff and Clinicians working on study. | Interviews will cover the following topics to assist in determining if a definitive future trial is feasible.
| Collect |
| Feasibility and Acceptability of Study Intervention through Qualitative interviews with participants who participated in the study. | Purpose of the interviews is to determine if a future definitive trial is feasible and acceptable for participants. Interviews will cover the following topics.
| Collected up to 130 weeks |
a global measure of Parkinson's severity that includes subsections looking at motor symptoms and signs, non-motor symptoms, activities of daily living and mood. Lower scores better. 4 subscales: non-motor 0-52, motor experience0-52, motor examination 0-132, motor complication 0-24.
| Collected at Baseline, 3 and 6 month follow up |
| Activity | Activity as captured using Activity diaries: types of activity; total number of minutes per day and per week at different levels of perceived exertion based on Borg scale 620. | Collected up to 6 months. |
| Activity Monitor Data | Step count, minutes of sleep (Rem, light, deep) and very & moderately active minutes using Fitbit Inspire HR activity monitors | Collected up to 6 months. |
| Short Form 12 (SF12) | measuring carer well-being, where a carer is available. Higher scores are better (Better health status). 50 is average score. 40-60 is range within 1 standard deviation of mean score. Scores 30-70 represent scores within 2 standard deviations of mean. There are subscales for Physical health and mental health. | Collected at baseline, 3 and 6 month follow up visit |
| Lindop Parkinson's Assessment Scale [LPAS] | Assessment of Gait (LPAS includes Timed up and Go) and transfers (timed bed transfers - included in LPAS) | Collected at baseline, 3 and 6 month follow up visit |
| Mini Balance Evaluation Systems Test (mini-BEST) | Questionnaire assessment | Collected at baseline, 3 and 6 month follow up visits |
| Tragus to Wall distance (posture assessment) | posture assessment. 10 cm - 12cm range is considered the better range. Higher scores up to 30cm in rare cases suggest worse health outcomes. | Collected at baseline, 3 and 6 month follow up visits |
| Number of Falls | Self reported outcome | Collected at baseline , 3 month and 6 month follow up visits. |
| D009422 | Nervous System Diseases |
| D009069 | Movement Disorders |
| D000080874 | Synucleinopathies |
| D019636 | Neurodegenerative Diseases |