Objective: A prospective study to investigate the effectiveness of the OT multimodal group therapy (‘CASH’ program-Care, Advocate, Share, Help) in improving the QoL of PD patients at the intermediate and advanced stage of disease & relieving the carers’ stress.

Background: Motor & non-motor symptoms of Parkinson’s patients aggravate when disease progresses to intermediate & advanced stage. PD patients will suffer frequent falls due to deteriorating motor symptoms which adversely affect their functional mobility and independence. They will have more anxiety & depression, decline in self-confidence & social withdrawal. Ultimately, resulting in poor QoL with increased carers’ stress. However, there is no former study for the effectiveness of a multimodal group therapy for PD patients at intermediate & advanced stage of disease as well as their carers’ impact.

Methods: Patients presented with intermediate and advanced stage of PD but able to manage ambulatory ADLs with assistance, with recurrent fall accidents or persistent high fall risks were recruited to this CASH program. Both PD patients & their carers had to participate 8 consecutive weekly group therapy sessions.The CASH program includes educational sessions on PD & fall prevention, weighted body integration exercise, relaxation technique, art & craft and 3 dance movement classes. 12 outcome measures were used to evaluate treatment effectiveness in functional, cognition, depression & anxiety, QOL & carer’s stress level.

Results: 28 patients were recruited with 7 dropped out. 21 patients and 18 carers were collected for statistical analysis with SPSS 19. Means were compared to investigate the effectiveness of the ‘CASH Program’. Statistical significant improvement was noted in Relative Stress Scale (RSS)-negative feelings between pre & post group (p=0.031); in Mattis Dementia Rating Scale (MDRS)-memory (0.018), MDRS-total (0.032) & PDQ8-bodily discomfort (0.016) between post & post group 8 week; in MoCA (p=0.038), RSS-life upset (p=0.056), RSS-negative feelings (P=0.008) & RSS-total (p=0.005) between pre & post group 8 week. Among three groups, there was clinical improvement noted in UPDRS I & III varied from 10% to 33%, while Geriatric Depression Scale (GDS) improved by 10% to 13% and Beck’s Anxiety Inventory (BAI) improved by 25%-28%.

Conclusions: This OT ‘CASH’ multimodal group program showed apparent positive effect and can empower the carers & PD patients at the intermediate & advanced stage in enhancing QoL, mood symptoms and relieving carer’s stress.

References: 1. Foster, E.R., Bedekar, M. & Tickle-Degnen, L. (2014). Systematic Review of the Effectiveness of Occupational Therapy-related Interventions for People with Parkinson’s Disease. The American Journal of Occupational Therapy Jan/Feb 68 (1): 39-49. 2. Sturkenboon IH et al (2014). Efficacy of occupational therapy for patients with Parkinson’s disease: a randomised controlled trial. Lancet Neurology, Jun;13(6): 557-66.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effectiveness-of-occupational-therapy-ot-multi-modal-group-program-for-parkinsons-patients-at-intermediate-advanced-stage-in-improving-quality-of-life-qol-relieving-carers-stress/