Outcomes of rehabilitation following device-aided therapy start in parkinson's disease: a randomized controlled trial.
Ann Björkdahl, Annika Khalif, Marie Gustafsson and 2 others
Rehabilitation added after device-aided therapy for Parkinson's left patients doing noticeably better on hands-on tasks at 6 and 12 months than standard care alone.
At 12 months, 19% of the rehab group fell below the independence threshold versus 54% of the control group.
Key findings
1The primary outcome (AMPS motor skill) showed a significant group effect favoring rehabilitation, with estimated means of 1.89 (rehab) versus 1.30 (standard care), and effect sizes of 0.75 at 6 months and 0.64 at 12 months.
2At 12 months, 19% of the rehabilitation group scored below the AMPS motor independence threshold versus 54% of the standard-care group; the same pattern held at 6 months (14% vs 48%).
3No significant between-group effects were found for AMPS process skill, Falls Efficacy Scale, Mental Fatigue Scale, or any Impact of Participation and Autonomy domain.
Still to come
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study was stopped at 54 of the planned 90 patients, so it was underpowered for secondary outcomes and the authors themselves flag this. The design was open-label: patients knew which group they were in, and the authors note non-significantly better baseline scores in the rehab group and a subjective-measure (EQ-VAS) effect without a parallel objective-measure effect, both consistent with a placebo or expectation component. The supervised rehabilitation dose was about 1 hour per week, well below the 170 minutes per week that a network meta-analysis the authors cite suggests is needed for meaningful improvement in Parkinson's; the authors call the intervention underdosed. The intervention was individualized and delivered by different local teams, making it hard to specify exactly what dose and content produced the effect. Secondary and exploratory outcomes were not corrected for multiple comparisons. Single-centre, single region in Sweden; generalizability to other health-system contexts is uncertain.
Declared interests
No conflicts of interest declared. Funded by Swedish government clinical-research funding, the regional research funder of Västra Götaland, the Norrbacka-Eugenia Foundation, and the Parkinson Foundation. The wrist-worn actigraphy device (Parkinson Kinetigraph) was provided in kind by Global Kinetics Corporation, Melbourne, Australia.
The easy way to misread this
Do not read the 1.8-point MoCA difference as proof that rehabilitation improves thinking in Parkinson's — the authors state this range is not clearly clinically important, the study was underpowered, and the open-label design means patients who knew they were receiving extra therapy may have performed better on the observed task. The one finding that is robust here is the motor-skill advantage on the AMPS, not a cognitive benefit.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →