Effects of Task-Based LSVT-BIG Intervention on Hand Function, Activity of Daily Living, Psychological Function, and Quality of Life in Parkinson's Disease: A Randomized Control Trial.

Only 14 people took part, from two hospitals in one country, over four weeks. The authors say themselves that the findings cannot be generalised to all people with Parkinson's. This is a small trial and the results could change with more participants. The two groups did not start out matched on disease severity: the task-based LSVT-BIG group averaged 2.43 on the Hoehn and Yahr scale and the comparison group 1.85. The difference was not statistically significant, but the group that improved more on daily activities was the group that started with more advanced disease. The comparison group was not untreated. Both groups received 30 minutes of conventional occupational therapy plus 40 minutes of something else, so what is being tested is the task-based LSVT-BIG content against progressive relaxation and stretching, not against no treatment and not against conventional occupational therapy alone. How much of the extra benefit came from the LSVT-BIG content, from the goal-setting, or simply from doing goal-directed activity cannot be separated out. Everyone was tested only at the end of the four weeks. There was no follow-up, so nothing is known about whether any of these gains lasted. Balance was not measured, even though the authors suggest that better balance is what improved the daily activity scores. The Berg Balance Scale was used only to decide who could join the study. The paper says the participants were blinded to their group assignment, but the two programmes look and feel completely different, so this is hard to take at face value. Nothing is said about whether the person scoring the tests was blinded. The primary outcome is never named, even though the paper says the sample size was calculated from it, so it is not possible to tell which of these results was the pre-planned question and which were secondary. The conclusion says the programme significantly improved hand function, daily activities, mental health and quality of life, but depression and quality of life did not differ significantly between the groups. The within-group improvements in both groups, including in the relaxation group, suggest some of the change may reflect time and attention rather than the specific programme.

Do not read the conclusion as proof that this programme beats standard occupational therapy on everything. Depression scores and quality of life changed in both groups with no significant difference between them, the one clear hand dexterity advantage over the comparison group was limited to the nondominant hand, and only 14 people were studied for four weeks with no follow-up. The comparison group was not untreated: it received the same 30 minutes of conventional occupational therapy plus 40 minutes of relaxation and stretching, so what this trial tests is the LSVT-BIG tasks against relaxation, not LSVT-BIG against nothing.