A randomized controlled study of whether setting specific goals improves the effectiveness of therapy in people with Parkinson's disease.

ABSTRACT

OBJECTIVE: To evaluate the effects of an intervention based on a specific set of goals on goal attainment, manual dexterity, hand grip strength and finger prehension force compared to a standardized approach in patients with Parkinson's disease. DESIGN: Randomized controlled trial. SETTING: Home-based. PARTICIPANTS: Fifty patients with a clinical diagnosis of Parkinson's disease acknowledging impaired manual ability were randomized into two groups. INTERVENTIONS: Patients in the experimental group ( n = 25) were included in an intervention focused on task components that involved goals proposed by participants. Patients in the control group ( n = 25) received a standard intervention focused on impairments in range of motion, grasp and manipulation. Home condition and duration (four weeks, twice a week) were similar in both groups. MAIN OUTCOME MEASURES: The primary outcome measure was goal achievement assessed with the Goal Attainment Scaling. Secondary outcomes were manual dexterity evaluated with the Purdue Pegboard Test and hand grip strength and finger prehension force assessed using a dynamometer. RESULTS: After four weeks, significant between-group improvement in goal attainment was observed in the experimental group (change 17.36 ± 7.48 vs. 4.03 ± 6.43, P < 0.001). Compared to the control group, the experimental group also showed a significant improvement ( P < 0.05) in manual dexterity (postintervention values in the most affected arm 10.55 ± 1.95 vs. 7.33 ± 3.63 pins, P < 0.001) and finger prehension force (postintervention values in the most affected arm 8.03 ± 1.93 vs. 6.31 ± 1.85 kg, P = 0.010). CONCLUSIONS: Targeting therapy toward specific goals leads to greater changes in arm function than a standardized approach in people with Parkinson's disease.