PEEP
Research type
Research Study
Full title
Is Physiotherapy Effective for people with Early Parkinson’s (PEEP)? A feasibility study
IRAS ID
277535
Contact name
Rob Skelly
Contact email
Sponsor organisation
University Hospitals of Derby and Burton NHS Trust
Clinicaltrials.gov Identifier
Duration of Study in the UK
2 years, 8 months, 14 days
Research summary
Research Summary:
Parkinson's disease is a progressive neurodegenerative condition affecting 145,500 people in the UK. The condition impairs movement leading to gait and dexterity problems. Various types of exercise are beneficial for both motor and non-motor symptoms such as depression.
The World Health Organisation's (WHO) recommendations on exercise include at least 150 minutes of moderate-intensity aerobic physical activity per week . People with Parkinson’s may struggle to achieve this because of movement problems and fatigue. Physiotherapists may have a role in persuading people to exercise and supporting them in their activity goals. While studies show that Parkinson’s patients with falls or gait freezing clearly benefit form physiotherapy, there is at present no robust evidence to demonstrate the impact of physiotherapy early in the course of the illness.
PEEP seeks to explore the effectiveness of physiotherapy for early Parkinson’s (ie within 4 years of diagnosis and before onset of falls).
It comprises three distinct parts:
1. A survey of people with Parkinson’s exploring their experience and opinions with respect to physiotherapy for early Parkinson’s
2. A feasibility randomised controlled trial (fRCT)
3. A qualitative process evaluation.
The fRCT will aim to recruit and randomise 40 people withParkinson’s who have been diagnosed in the last 4 years and have had no physiotherapy. These participants will undergo several assessments at baseline, 3 months and 6 months, and will also have 7 days’ worth of activity monitoring done via physical diary and a commercially available activity tracker to determine levels of activity. Participants randomised to the intervention arm will also receive 5 physiotherapy sessions (1 for assessment and 4 for treatment) additional to standard NHS care.
Staff and some participants involved in the fRCT will be included in a qualitative process evaluation to assess the acceptability and feasibility of the intervention and the research assessments.Summary of Results:
We conducted a patient survey and a randomised controlled feasibility trial.
1.1 The survey
The survey explored the attitudes and experiences of people with early Parkinson’s (less than 4 years for diagnosis) to exercise, technology and physiotherapy. It was posted online and paper copies were distributed at local Parkinson’s groups in Derby and Northumbria UK between Novemebr 2021 and July 2022. 274 people with early Parkinson’s (completed the survey. Most (96%) completed the survey online.
Attitudes to exercise. Nearly two thirds (62%) reported exercising at least 4 times per week and most (88%) thought exercise we was very or extremely important for staying well with Parkinson’s. More than 15% of respondents identified each of the following barriers to exercise: apathy, motor Parkinson’s symptoms, exhaustion and lack of time. Key facilitators for exercise were Parkinson’s-specific exercise classes and exercise partners.
Use of technology. Most respondents (97%) reported regular use of technological devices and 88% used smart phones. More than 50% reported using a smart phone to monitor their physical activity by counting steps. 36% of respondents had had a video consultation in the year before the study and most reported it had gone well. Because most of the participants of this survey responded online the results may not represent the true extent of use of technology in the UK Parkinson’s population.
Physiotherapy. About half (53%) of respondents reported having had physiotherapy for Parkinson’s. Mostly (76%) physiotherapy was delivered face to face. Usually more than one session was offered. 64% of those who had physiotherapy thought it was helpful but more than half (54%) thought too little exercise was offered. Of those not offered physiotherapy, about a half (52%) thought they should have been offered physiotherapy.
1.2 The randomised controlled feasibility trial. This study explored personalised, real-time physiotherapy delivered via a video call. This approach is sometimes called telerehabilitation. The main aim of the study was to see if we could recruit participants, deliver the therapy as planned via the video link, and collect data to assess if this type of physiotherapy is useful. 84 people were screened for eligibility, 64 were eligible and 40 consented to take part. 21 were randomised to the physiotherapy via video link intervention and 19 to usual care. We were able to recruit participants in the agreed time frame. 90% of the planned assessments were completed. Most of the physiotherapy sessions took place as planned. Only around 50% of the activity monitor data was usable. 6 months after the start of the study, Parkinson’s severity reduced (as measured by UPDRS) in the intervention (physiotherapy) group but increased in the control group. Quality of life (as measured by PDQ-39) improved marginally in both physiotherapy and control groups at 6 months. Median change in 7-day step count (measured by Fitbit) was 4215 in the physiotherapy group and -2185 in the usual care group. While this data is encouraging, it is insufficient to claim any effect for the intervention. It would be feasible to conduct a larger randomised controlled trial but a more reliable way of measuring step count would be needed.REC name
West Midlands - South Birmingham Research Ethics Committee
REC reference
20/WM/0078
Date of REC Opinion
4 May 2020
REC opinion
Further Information Favourable Opinion