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Upper-limb assessment in people with Parkinson disease: is it a priority for therapists, and which assessment tools are used?

ABSTRACT: PURPOSE: To investigate the frequency of physiotherapy and occupational therapy assessment of the upper limb (UL) in people with Parkinson disease (PD) and to identify the impairments and activity limitations assessed and the methods used. METHOD: A custom-designed questionnaire was used to survey physiotherapists and occupational therapists with previous experience in managing people with PD, using targeted recruitment to invite physiotherapy conference attendees, clinicians employed in movement disorders programmes, and practitioners in neurology and gerontology to respond either on paper or online. RESULTS: Of the 190 respondents (122 physiotherapists, 68 occupational therapists), 54% reported consistently assessing the UL. A majority (>60%) assessed impairments specific to PD, but few quantified these using standardized measures. Activity limitations, largely relating to manual dexterity, were assessed using observational analysis (61%), non-standardized timed activities (46%), and standardized outcome measures (61%), most generic or developed for evaluating other neurological conditions. More than 10% of respondents could not identify an appropriate standardized measure. CONCLUSIONS: Slightly more than half of respondents regularly assessed the UL. Respondents reported widespread use of non-standardized methods to assess PD-specific impairments. Standardized measures were more frequently used to evaluate activity limitations, but despite the unique movement disorders associated with PD, the clinimetric properties of most of the tools identified have not been established in this population. Education and further clinimetric investigation of measures in use are needed to facilitate evidence-based practice in this area.

SUBMITTER: Proud EL

PROVIDER: S-EPMC3817870 | biostudies-other | 2013

REPOSITORIES: biostudies-other

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Upper-limb assessment in people with Parkinson disease: is it a priority for therapists, and which assessment tools are used?

Proud Elizabeth L EL Miller Kimberly J KJ Martin Clarissa L CL Morris Meg E ME

Physiotherapy Canada. Physiotherapie Canada 20130101 4

<h4>Purpose</h4>To investigate the frequency of physiotherapy and occupational therapy assessment of the upper limb (UL) in people with Parkinson disease (PD) and to identify the impairments and activity limitations assessed and the methods used.<h4>Method</h4>A custom-designed questionnaire was used to survey physiotherapists and occupational therapists with previous experience in managing people with PD, using targeted recruitment to invite physiotherapy conference attendees, clinicians employ ...[more]

PMID: 24396156

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Project description:OBJECTIVES:To survey the reported content, frequency and duration of upper limb treatment provided by occupational and physiotherapists for people after stroke in the UK. DESIGN:A cross-sectional online survey was used. Description and analysis of the data were based on items from the Template for Intervention Description and Replication (Who, Where, What and How much). SETTING:The online survey was distributed via professional and social networks to UK-based therapists. PARTICIPANTS:Respondents were occupational or physiotherapists currently working clinically in the UK with people after stroke. Over the 6?week data collection period, 156 respondents opened the survey, and 154 completed it. Respondents comprised 85 physiotherapists and 69 occupational therapists. RESULTS:Respondents reported treating the upper limb a median of three times a week (range: 1 to 7) for a mean of 29?min (SD: 18). Most (n=110) stated this was supplemented by rehabilitation assistants, family and/or carers providing additional therapy a median of three times a week (range 1 to 7). Functional training was the most commonly reported treatment for people with mild and moderate upper limb deficits (>40%). There was much less consistency in treatments reported for people with severe upper limb deficits with less than 20% (n=28) reporting the same treatments. CONCLUSIONS:This study provides a contemporaneous description of reported therapy in the UK for people with upper limb deficits after stroke and a detailed template to inform standard therapy interventions in future research. Several evidence-based therapies were reported to be used by respondents (eg, constraint induced movement therapy), but others were not (eg, mental imagery). The findings also highlight that the current reported provision of upper limb therapy is markedly less than what is likely to be effective. This underlines an urgent need to configure and fund services to empower therapists to deliver greater amounts of evidence-based treatment for people with upper limb deficits after stroke.

Project description:ObjectiveTo determine research priorities for the management of broken bones of the upper limb in people over 50, which represent the shared priorities of patients, their families, carers and healthcare professionals.Design/settingA national (UK) research priority setting partnership.ParticipantsPeople aged 50 and over who have experienced a fracture of the upper limb, carers involved in their care, family and friends of patients, healthcare professionals involved in the treatment of these patients.MethodsUsing a multiphase methodology in partnership with the James Lind Alliance over 15?months (September 2017 to December 2018), a national scoping survey asked respondents to submit their research uncertainties. These were amalgamated into a smaller number of research questions. The existing evidence was searched to ensure that the questions had not already been answered. A second national survey asked respondents to prioritise the research questions. A final shortlist of 25 questions was taken to a multi-stakeholder workshop where a consensus was reached on the top 10 priorities.ResultsThere were 1898 original uncertainties submitted by 328 respondents to the first survey. These original uncertainties were refined into 51 research questions of which 50 were judged to be true uncertainties following a review of the research evidence. There were 209 respondents to the second (interim prioritisation) survey. The top 10 priorities encompass a broad range of uncertainties in management and rehabilitation of upper limb fractures.ConclusionsThe top 10 UK research priorities highlight uncertainties in how we assess outcomes, provide information, achieve pain control, rationalise surgical intervention, optimise rehabilitation and provide psychological support. The breadth of these research areas highlights the value of this methodology. This work should help to steer research in this area for the next 5-10 years and the challenge for researchers now is to refine and deliver answers to these research priorities.

Project description:The number of smartphone users globally is rapidly increasing. This study aimed to assess the level of ergonomic risk to smartphone users, and to evaluate the correlation between any self-reported musculoskeletal disorders and the level of ergonomic risk. Thirty participants completed a questionnaire, tailored specifically for smartphone users, to determine any musculoskeletal disorders. Participants were given a seated smartphone texting task and their postures were video recorded during the task. The video scenarios were evaluated by three independent researchers to determine the level of ergonomic risk using the Rapid Upper Limb Assessment (RULA) tool. RULA is an observation-based screening tool which has been widely used to assess the postural risk of IT device users. However, it has not yet been specifically utilized with smartphone users. The RULA tool scores identified ergonomics risks from using smartphones to text. Most smartphone users had a total RULA Grand Score of 6 for both sides (left side: 80.00%, right side: 90.00%), indicating the need for further investigation and changes (Action Level 3). Notably, no participants had acceptable RULA Grand Scores of 1 or 2. The correlation between musculoskeletal disorders and the ergonomic risk among smartphone users was determined using the Chi-Square test and Fisher's exact test; p<0.05 was considered statistically significant. There was a significant correlation between right RULA Grand Score and neck musculoskeletal disorder (?2 = 9.424 at p value = 0.009) and right RULA Grand Score and upper back musculoskeletal disorder (?2 = 31.717 at p value <0.001). RULA Score B (combination of neck, trunk and leg postures) and RULA Score D (combination of Score B, muscle use and force scores for group B) were also significantly correlated with neck musculoskeletal disorders (?2 = 19.286 at p value<0.001 and ?2 = 9.310 at p value = 0.002 respectively). The RULA results identified the high ergonomics risk of smartphone users, this resulted from two key risk factors: posture and muscle use. The neck, trunk and leg postures had a combined effect on neck musculoskeletal disorders. Future investigations should consider these factors when designing ergonomic interventions for smartphone users.

Dataset Information

Upper-limb assessment in people with Parkinson disease: is it a priority for therapists, and which assessment tools are used?

Publications

Upper-limb assessment in people with Parkinson disease: is it a priority for therapists, and which assessment tools are used?

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