Current issues of ACP Journal Club are published in Annals of Internal Medicine


Therapeutics

Patient education and health promotion improved symptoms of Parkinson disease

ACP J Club. 1995 May-June;122:64. doi:10.7326/ACPJC-1995-122-3-064


Source Citation

Montgomery EB, Lieberman A, Singh G, Fries JF, and the remaining members of the PROPATH Advisory Board. Patient education and health promotion can be effective in Parkinson's disease: a randomized controlled trial. Am J Med. 1994 Nov;97:429-35.


Abstract

Objective

To evaluate the effectiveness of a patient education and health promotion program in slowing the rate of symptoms and disability progression in patients with Parkinson disease.

Design

Randomized controlled trial with 6-month follow-up.

Setting

The health promotion program (PROPATH).

Patients

322 (mean age 69 y) of 400 patients consecutively enrolled in the ongoing PROPATH Program who had self-reported Parkinson disease and a diagnosis independently confirmed by their physicians. Follow-up was 90%.

Intervention

155 patients were assigned to receive the intervention, which consisted of mailed disease-assessment questionnaires completed by the patient or caregiver at baseline and at 2, 4, and 6 months. Computer-generated reports and individualized recommendation letters and reports were returned to the patients and their physicians. 167 patients assigned to the control group received the questionnaires only.

Main outcome measures

Self-report of Parkinson scores as measured by the Unified Parkinson's Disease Rating Scale, amount of exercise, and use of medication and medical services.

Main results

Patients in the control group reported worsened on-scores, off-scores, and summary scores of the Unified Parkinson's Disease Rating Scale (P ≤ 0.001), increased use of levodopa (P = 0.001), and a higher side-effect index (P = 0.018). Patients in the intervention group reported that they exercised more (P < 0.001) and visited their physician less frequently (P = 0.03). Between-group change scores were significant for on-score (P = 0.033), off-score (P = 0.011), and summary score (P = 0.007), and for the number of patients exercising (P = 0.001) and the use of levodopa (P = 0.019). Group comparisons for the other Parkinson scores from the Unified Parkinson's Disease Rating Scale, exercise, medication use, and use of medical services were not significantly different.

Conclusion

A patient education and health promotion program improved some of the Unified Parkinson's Disease Rating Scale scores, increased the amount of exercise, and reduced the amount of levodopa used in patients with Parkinson disease.

Source of funding: In part, Sandoz Pharmaceuticals.

For article reprint: Dr. J.F. Fries, 1000 Welch Road, Suite 203, Palo Alto, CA 94304, USA. FAX 650-723-9656.


Commentary

Although patients with chronic disease would prefer a "cure," most physicians would be satisfied if they could provide treatments that reduce morbidity or delay disease progression. A mailed health promotion program, PROPATH, was designed by Healthtrac, Inc., and sponsored by Sandoz Pharmaceuticals for patients with Parkinson disease who were receiving medication. PROPATH aimed to improve functional outcomes using an education strategy of enhanced personal self-efficacy and optimism, information, and improved function through exercise. Patients received individualized, computer-generated recommendation letters and reports summarizing progress. The authors hypothesized that the program would be effective in lessening symptoms and the progression of disability through changes in exercise level, perceived self-efficacy, and side-effects.

The patients in the trial apparently were selected from among persons who had already completed enrollment cards for PROPATH. Motivation was probably high as shown by the high participation and completion rates; at baseline, > 50% of the group exercised 7 times per week.

The program slowed the progression of symptoms based on patients' self-reports. It is difficult to know whether the differences based on self-report would correspond to more objective measures of disease severity. Potential validity is threatened by self-efficacy and optimism. I wonder about the durability of the effect after 6 months.

The study does show that in highly motivated patients with Parkinson disease, measurable effects will probably result from a well-designed, rather low-dose program that stresses education, self-efficacy, and increased exercise. The effects are modest but worthwhile. Parkinson disease will progress inevitably, and at some stage these efforts may become irrelevant, especially for patients who develop moderate-to-severe dementia or other disabling complications. I recommend that practitioners work to promote regular exercise, knowledge of the disease and drug side effects, and self-efficacy and confidence in self-care.

Eric B. Larson, MD, MPH
University of Washington Medical CenterSeattle, Washington, USA