Robert C. Wagenaar - US grants

[unreadable] DESCRIPTION (provided by applicant): The overall goal of the proposed research is to determine whether rehabilitation that focuses on self-management of health helps to improve the day-to-day functioning and quality of life of community-living clients with Parkinson's disease (PD), beyond the effects of medical treatment alone. Typically for people with PD, medical treatment declines in effectiveness over a variable number of years, and these individuals face a relentless progression into disability and lowered quality of life that can end in a need for custodial care. If a rehabilitation program can ameliorate disability and support a high quality of life by positively influencing mobility, communication, and healthful daily living skills, it is possible that more intensive use of medication could be postponed. As a result, people with this disease might benefit longer from medication and be less quickly referred to costly inpatient rehabilitation and long term care facilities. The proposed research uses rigorous methodology, which is rare for studies of rehabilitation with this population, and builds on our previous research toward understanding the role of rehabilitation in promoting health in people with PD. In a randomized controlled design, people with PD will be assigned to one of three conditions for a duration of 6 weeks: (i) medication only, (ii)medication plus 2 outpatient group rehabilitation sessions and 1 social activity session per week, or (iii)medication plus 2 outpatient group rehabilitation sessions and 1 home/community rehabilitation session per week. Rehabilitation will occur through integrated physical, occupational, and speech therapy services specialized to the self-management of health needs of people with PD. The first specific aim of the proposed study is to determine if increasing "doses" of self-management rehabilitation (from Conditions i to ii to iii) result in increasingly positive quality of life outcomes. The second aim is to document change in rehabilitation effects at 2 and 6 months post-intervention. The third aim is to describe possible active ingredients in the rehabilitation by measuring neuromuscular and voice function outcomes. The fourth aim is to provide evidence for the validity of self-management outcome measures for use with PD. It is hypothesized that there will be beneficial and lasting effects of rehabilitation for quality of life outcomes. [unreadable] [unreadable]

Functional decline with aging increases the risk of disability, dependency, falls, and mortality;therefore, there is growing interest in the development of function promoting anabolic therapies (FPTAs) for the treatment and prevention of aging-associated functional limitations. In addition, very limited information is available on how FPATs affect the levels of functional activities (e.g., walking, stair climbing, running, biking, etc.) in the home and community based setting. It has been argued that functional activities in the home environment are an excellent integrated measure of physical function. It is open to further investigation whether administration of FPATs results in clinical benefits measurable at the level of functional activities. In other words, there is a pertinent need for the development of reliable, valid and responsive measures for the assessment of (reduced) level of activity in the evaluation of older individuals participating in clinical trials of FPATs. In general, a thorough understanding of functional limitations in older Americans requires the continuous measurement of functional activities as well as environmental constraints in the home and community based setting. Previous work by our research group has demonstrated that functional activities in the home and community based setting lasting longer than 5 seconds can be accurately and reliably assessed with an Activity Monitor (AM;2,3). The advantage of the AM compared to questionnaires is that it allows for continuous assessment of functional activities, which will improve the responsiveness to treatment effects. However, its current design has a number of limitations related to maximal hours of date recording, energy supply, the extraction of recorded date, the size of the data-logger attached to the body, the algorithms used in data-reduction and the assessment of environmental barriers (see Section 2: Background, Previous Research and Significance).