Measuring the Impact of Physiotherapy for Parkinson s Disease

Transcription

1 CTN Conference 2009 Measuring the Impact of Physiotherapy for Parkinson s Disease Fiona Lindop Specialist Physiotherapist

2 Outline Importance of choosing the right outcome measure Unified Parkinson s Disease Rating Scale (UPDRS) Lindop Parkinson s Assessment Scale (LPAS) Other outcome measures available Resources for Physiotherapists

3 Characteristics of a Useful Measure: NICE Guideline: MS Domain Feasibility Utility Validity Reliability Sensitivity Communicability Question(s) Can it be used in this situation? Will process be acceptable to patient? Is it useful? Worth the time & effort? Will it measure what I want? Doe it include unrelated phenomena that reduce its validity? How much variation from time to time when no real change? Variation between observers? Will it detect change? Does it cover whole range of possible change? Can I communicate the result? Will other people understand the result?

4 Unified Parkinson s Disease Rating Scale (UPDRS) Comprehensive and complex scale (44 items overall) Motor examination section = 27 items Each item scored on an ordinal scale from 0 to 4 Most widely used scale in clinical research and practice

5 MDS-UPDRS Part Non-motor + motor experiences of daily living 6 questions to rater, 20 patient questionnaire Part 3 Motor exam: 19 sections Part 4 Motor complications: patient & rater complete together

6 Lindop Parkinson's Assessment Scale (LPAS) Objective physiotherapy-specific functional scale measuring: Gait mobility scored out of 18 Bed mobility scored out of 12 Base line assessment Effectiveness of intervention Progression of disease Drug effectiveness Pearson M, Lindop F, Mockett S, Saunders E Validity and Inter-rater reliability of the Lindop Parkinson s Disease Mobility Assessment: A Preliminary study. Physiotherapy 95 (2009) pp

7 LPAS

8 Sections of LPAS Gait mobility Sit to stand TUSS TUG 180 Turn left/right Walking through doorway Bed mobility Sit to lie Roll to left Roll to right Lie to sit

9 LPAS Validation Study 49 subjects with PD recruited: 33 male, 16 female years Stage 1-4 Hoehn & Yahr 2 raters (A & B) concurrently performing the LPAS and the UPDRS (Motor Section) RESULTS LPAS was found to : Have high concurrent validity compared with the UPDRS motor examination Have high inter-rater reliability Be quick and easy to use - vital for busy clinician Provided objective information about functional gait & bed mobility

10 Other Physical Tests Available for PD Parkinson s Activity Scale (PAS) measures gait & transfers Timed-up & Go 6 minute walk test/ 10 meter walk/ 2 minute walk Retropulsion test Berg Balance Tragus to wall test (posture)

11 Questionnaire Outcome Measures Patient Specific Complaints Questionnaire (goals) The General Practice Physical Activity Questionnaire (GPPAQ) Phone-FITT (Gill et al 2008) EQ-5D- measure of health (5 items) PDQ-39 Modified Dyskinesia Scale

12 PDQ39 - Quality of Life Survey 1.Constipation 2.Urinary dysfunction 3. Sleeplessness 4. Speech 5. Pain/cramps 6. Confusion 7. Hallucinations 8. Diet 9. Drooling 10.Vision

13 Questionnaires Related to Freezing & Falls Freezing of Gait- Severity & frequency of freezing History of Falling- therapist asks about falls & near falls Falls Diary- completed after every fall by patient/carer Falls Efficacy Scale- International (FES-I) measures confidence in maintaining balance & fear of falling 2 versions: full 16-item; shortened 7 item

14 Resources Available Quick Reference Cards (UK) and Guidance Notes for Physiotherapists working with people with PD (2009) Association of Physiotherapists in PD Europe (APPDE) APPDE DVD Practical Guidelines for Physiotherapy in PD ( 14) PDS Professionals Guide CD-Rom Using cueing to improve mobility in PD

15 And Finally... Always use outcome measures to ensure good practice and evaluation Try to be consistent with each repeat of the outcome measure chosen Select which one to use don t apply all of them to every patient! Fiona.lindop@derbyhospitals.nhs.uk

16 References NICE guideline: multiple sclerosis (November 2003) Pearson M, Lindop F, Mockett S, Saunders E Validity and Inter-rater reliability of the Lindop Parkinson s Disease Mobility Assessment: A Preliminary study. Physiotherapy 95 (2009) pp Ramaswamy B. et al Quick Reference Cards (UK)& Guidance notes for physiotherapists working with people with PD PDS(2009) Keus et al Guidelines for physical therapy in patients with PD Dutch Journal of Physiotherapy (2004)114(3) supplement 1-94