CompletedPsychology & BehaviourBrain & Nervous System
Physiotherapy and occupational therapy versus no therapy in mild to moderate Parkinson's disease: a large pragmatic randomised controlled trial (PD REHAB)
A large trial is testing whether NHS physiotherapy and occupational therapy actually improve daily life for people with Parkinson’s disease who struggle with everyday tasks. Many people with Parkinson’s receive these therapies, but their clinical and cost-effectiveness has never been rigorously tested in a large, real-world trial. Without clear evidence, the NHS cannot know whether it is funding treatments that genuinely help patients or wasting resources on ineffective care. This trial directly addresses that gap. If the therapies prove effective, the NHS could confidently expand access to home-based physiotherapy and occupational therapy for Parkinson’s patients, improving their ability to dress, cook, and manage household tasks. If they do not, the NHS could redirect funding to interventions that work. Either way, the results will help clinicians and commissioners make evidence-based decisions about a common, costly treatment. The trial is pragmatic and reflects real NHS practice, so its findings will be immediately applicable to routine care.
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The aim of PD REHAB is to evaluate the clinical and cost-effectiveness of NHS occupational therapy (OT) and physiotherapy (PT) in patients with Parkinson's disease (PD) who report limitations in activities of daily living. The trial is a large, pragmatic, multicentre, randomised, controlled trial of OT and PT versus no therapy in 750 patients with PD and limitations in activities of daily living from approximately 40 elderly care and neurology units throughout the United Kingdom. PT and OT will be administered in the patient's home. The framework for the content of the therapy will be agreed in advance by expert groups based on our previous work on standard NHS OT and the PT Evaluation Project. Therapy will be tailored to the individual patient's requirements. Trial therapists will have a spectrum of experience, so we will provide an initial training day for therapists as they join the trial to ensure uniformity of practice across the country. Therapists providing the intervention will complete intervention record forms, as used in previous complex intervention trials, to allow us to monitor intervention delivery. We have successfully piloted some of these forms in the PD OT trial. The primary outcome measure will be instrumental activities of daily living (Nottingham Extended Activities of Daily Living scale) as activities of daily living is the target of the intervention. Secondary outcomes will be: health-related quality of life (Parkinson's Disease Questionnaire 39; EuroQol EQ5D), cost-effectiveness (cost per quality adjusted life year), adverse events and carer quality of life (Short Form 12. Outcomes will be assessed before randomisation and by post at 3, 9 and 15 months.
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