Demographic sample characteristics

Recruitment took place from September 2018 to June 2020. After the assessment and review of the inclusion and exclusion criteria, n = 386 patients were asked to participate. N = 113 of these eligible patients refused to participate. A total of n = 273 PD patients were willing to participate after being informed about the study and data protection and included n = 123 IG and n = 150 CG participants. For a total of 230 PD patients, the data for all three measurement times were available, which included n = 93 for IG and n = 137 for CG. Follow-up data collection took place from June 2019 to January 2020 for the CG and from April 2020 to April 2021 for the IG. The detailed sample flow is shown in Fig. 2.

Fig. 2
figure 2

The demographic and Parkinson-related characteristics of the IG and CG are listed in Table 2. On average, the patients had been suffering from PD-specific symptoms for approximately 9 years. The disease was diagnosed at an average of approximately 8 years prior to the study. The sample groups included more men than women in both groups. There were significant differences in age, education, household net income and occupational status, BMI, and degree of disability. The average age for the IG was 64 years, and for the CG, it was just under 68 years. The participants in the IG had, on average, higher educational levels. In the IG, just under 30% and in the CG, 16% were employed. The disease severity, according to Hoehn & Yahr, averaged approximately 2.5 for both groups.

Table 2 Sample characteristics

Loss to follow-up

To assess the risk of bias due to dropouts, a nonresponder analysis was conducted for the IG and CG. The sociodemographic, as well as primary and secondary outcome measures, were examined. For both the IG and CG, there were no significant differences with regard to the examined outcomes.

Primary and secondary outcomes

Most of the primary and secondary outcomes were comparable at baseline in both groups. The values indicated the burdens in both the IG and CG. Participation was statistically significantly more limited at the start of MKP in the CG than in the IG. For the PHQ-4 total scores, the IG also achieved significantly better values than the CG. With regard to performance, it was noticeable that those who were employed (IG: n = 26, CG: n = 21) felt very limited in this area. In everyday life, a greater number of CG patients felt that their performance was significantly inferior compared to the IG patients.

Both the IG and CG achieved significant improvements at the end of MKP with small to medium effect sizes for all target parameters. Both groups benefited from MKP to a similar extent. There were only significant differences in the group comparisons for the FES-I, PHQ-4 total score and PHQ depressiveness variables. There were no significant differences between the groups over time. There also were no significant differences with regard to pain at the end of MKP.

For both the CG and IG, a decrease in the effect on the primary outcome (quality of life) at nine months after MKP, when compared to the baseline, was recognisable but was less pronounced for the IG than CG. The difference did not reach statistical significance. The patients in both groups deteriorated in terms of nearly all primary and secondary outcome variables at catamnesis. However, this deterioration was less pronounced in the IG than in the CG. For the IMET, a significant slightly positive effect was observed in the IG. The IG remained slightly below baseline. The primary and secondary outcomes over time are shown in Table 3. There were no significant differences between the groups in terms of medically diagnosed comorbidity and pain at nine months after the end of MKP.

Table 3 Primary and secondary outcomes over time

Health status

The general health status of the patients in the IG and CG at t0 was similarly distributed. Only approximately 18.5% of IG and 13.2% of CG participants described their health status as “very good” or “good”, whereas approximately 34.7% of IG and 46.3% of CG perceived their health status as “less good” or “poor”. Approximately one-fifth of the IG patients (n = 19) had fallen an average of 8.5 times (SD = 17.1) in the 6 months before MKP. In the CG, almost half of the patients reported having fallen (n = 57) and had fallen an average of 6.2 times (SD = 19.8). In addition to PD, the study participants had an average of two other diseases. High blood pressure was reported as the most common comorbidity by both the IG and CG, which was followed by osteoarthritis and elevated blood lipid levels. The patients in both groups predominantly reported pain in the back and shoulder–neck area and in the lower limbs.

The general health of the participants improved in both groups at the end of MKP. Forty-four percent of the IG and approximately one-third of the CG patients (32.6%) described their own state of health as “good” or “very good”. Nearly 40% of the IG and 45% of the CG respondents perceived their state of health to be “satisfactory”. There were no statistically significant differences between the groups. The improvements in health status compared to that before the MKP were statistically significant, with an SRM of 0.51 for the IG and 0.55 for the CG (p < 0.01).

With regard to the number of falls during MKP, the groups did not differ: n = 4 IG patients fell an average of 2 times, and n = 17 CG patients fell 2.2 times.

Nine months after MKP, the CG patients rated their general state of health as significantly worse than the IG patients (Fig. 3). Thus, 29.2% of the IG and approximately half of the CG respondents (50.4%) assessed that their state of health was “less good” or “poor”. When examining their health status over time, it was noticeable that it improved slightly in both groups after MKP. Nine months after the end of MKP, however, it deteriorated again. For the case of the IG, however, the state of health did not decrease to the initial level but remained slightly better. For the case of the CG, on the other hand, the state of health deteriorated beyond the initial level (SRM: CG (t0-t2): -0.07, IG (t0-t2): 0.12).

Fig. 3
figure 3

On average, n = 39 IG patients fell 5 times and n = 59 CG patients fell almost 8 times in the first nine months after MKP. The difference between the groups did not reach statistical significance.

Use of health services

Nearly all patients in both groups at baseline had sought medical help in the previous six months. Eighty-eight percent of the IG and 85% of the CG patients had seen a neurologist in the previous six months before the start of MKP, and nearly 82% of the IG and 84% of the CG patients had seen a general practitioner. A total of 80% of the patients in both groups had used the services of one or more therapists in the previous six months. The patients in both groups were most often in physiotherapeutic treatment, and this was statistically significantly more often for the CG than the IG. N = 28 patients with IG (36.4%) and n = 49 patients with CG (63.6%) had been hospitalised in the previous 6 months before MKP onset. In addition to Parkinson’s-specific medications, few others were taken. Antidepressants/psychotropic drugs were taken daily by 19% of the IG and 16.1% of CG patients. Ten percent of the IG and 15.7% of CG patients took sedatives and sleeping pills daily. More than half of the patients (IG: 54.1%, CG: 59.5%) also took other prescription drugs daily.

Physical activity

The IG and CG did not differ significantly in terms of physical activity at baseline. Approximately one-third of the IG (33.3%) and CG patients (38%) were physically active for more than two hours a week at the start of MKP. Likewise, approximately one-third of the study participants (IG: 34.4%; CG: 32.1%) were active 1–2 times a week. Another third (IG: 32.3%; 29.9%) exercised less than once a week. A total of 44.1% of the IG patients and 51.1% of the CG patients stated that they paid either much or very much attention to engaging in adequate amounts of physical activity. None of the patients in either the CG or IG stated that they paid no attention to physical activity.

In both groups, the proportions of patients who were physically active for more than two hours a week increased nine months after MKP. The groups did not differ significantly from each other at either measurement time, and no significant effects were detected over time (Table 4).

Table 4 Extent of physical activity over time

The proportions of patients who paid much to very much attention to exercise increased slightly in the IG group in the catamnesis survey, while the proportions decreased slightly in the CG. There were no significant differences at the group level or over time (Table 5).

Table 5 Attention to physical activity over time

Occupational participation

At statistically significant levels, more patients in the IG were employed at baseline than in the CG (IG: n = 26, 28.3%; CG: n = 21, 15.8%). In the previous six months, n = 22 employed IG patients had been on sick leave for an average of nearly three weeks, and n = 19 CG patients had been on sick leave for an average of nearly 2.5 weeks. These differences in duration did not reach statistical significance. Occupational risks were calculated using the SPE scale (a scale for measuring the subjective prognosis of employment) [39, 40]. In both the IG and CG, the risk scores were high in slightly more than half of the patients. More than half of the IG patients and nearly two-thirds of the CG patients who were still working assumed that they would not be able to work until they reached retirement age. Nearly 70% of the IG and nearly 80% of the CG patients believed that their ability to work was permanently at risk. Approximately 40% of the patients in both groups were currently considering applying for a disability or occupational disability pension. There were no statistically significant differences between the groups for any of the described variables. N = 14 of the employed IG, and n = 12 of the employed CG participants stated that their professional situations had changed in the previous three years because of their PD.

Additionally, nine months after MKP, significantly more patients in the IG (n = 23, 25%) than in the CG (n = 15, 11.8%) were employed. Thus, there was one fewer employed patient in the IG and six fewer employed patients in the CG than at baseline. The sick leaves in the previous nine months lasted approximately three weeks in the IG and CG. For the IG, the number of sick leaves thus remained more or less the same, while the patients in the CG were on sick leave for half a week longer on average than at baseline. The difference is not significant. Approximately half of the patients in both groups belonged to the two highest risk groups, which approximately corresponded to the baseline value.

Intervention

Ninety percent of all IG patients felt “moderately motivated” or “very motivated” by the training programme to become physically active (Fig. 4).

Fig. 4
figure 4

Assessment of motivation for physical activity through the training programme

Individual aspects of the intervention motivated the patients to exercise. The most motivating aspects for the IG were the idea of doing something good for their own bodies by performing the exercises and having regular consultations with the physiotherapist, which were followed by the continuous adjustments of the training plan and the requirement to train three times a week (Fig. 5).

Fig. 5
figure 5

Assessing the motivation of individual aspects of the training programme

The patients found that both regular telephone calls with the physiotherapist (“very helpful” and “moderately helpful”: 85.6%) and introductory seminars in the clinic (“very helpful” and “moderately helpful”: 75.6%) were mostly helpful to enable them to use the training programme at home.

All patients benefited from using the programme (“somewhat” to “a lot”: 94%). Above all, the patients benefited from the fact that they learned helpful exercises for use in their future self-training. The majority of patients also felt that regular performance of the exercises had a positive influence on their PD (Fig. 6).

Fig. 6
figure 6

Assessment of individual statements on the training programme

Overall, the patients were satisfied with the training programme (“satisfied” to “very satisfied”: 98.8%). The aspects that contributed most to this satisfaction were telephone calls with the physiotherapist, using the tablet, the individually focused training plans and the training video presentations (Fig. 7).

Fig. 7
figure 7

Assessment of satisfaction with individual aspects of the training programme

Only 16.7% of the IG patients reported operating difficulties with the programme, which occurred between one and eight times. Some technical problems occurred during the intervention period. The most frequently mentioned issues were intermittent sound drop outs, a programme crash and inadequate programme volume.

Statistical control of the differences in baseline values of the outcome variables and sociodemographic characteristics

A regression analysis was conducted to control for the differences in primary and secondary outcomes (baseline values) as well as for the sociodemographic characteristics (age, education and occupational status) at baseline. The analysis showed that the previous results for the primary outcome, PDQ-8, and for the secondary outcome, IMET, were mostly replicated.

In the analysis of the other secondary outcomes, statistically significant differences in the change values that favoured the IG were found for the total PHQ-4 scores, PHQ-depression scores, performance (leisure time as well as performance) in daily life (when controlling for the differences in baseline values) and for the PHQ-depression scores, performance—leisure time as well as performance—daily life (when controlling for the differences in baseline values and socio-demographic characteristics) at the second follow-up time point.

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