A long-term self-managed handwriting intervention for people with Parkinson's disease: results from the control group of a phase II randomized controlled trial

作者：Collett Johnny^*; Franssen Marloes; Winward Charlotte; Izadi Hooshang; Meaney Andy; Mahmoud Wala; Bogdanovic Marko; Tims Martin; Wade Derick; Dawes Helen

来源：Clinical Rehabilitation, 2017, 31(12): 1636-1645.

DOI：10.1177/0269215517711232

• Parkinson's disease
• micrographia
• handwriting
• motor symptoms
• randomized controlled trial

Objective: To report on the control group of a trial primarily designed to investigate exercise for improving mobility in people with Parkinson's disease (pwP). The control group undertook a handwriting intervention to control for attention and time spent practising a specific activity.
Design: Secondary analysis of a two-arm parallel phase II randomized controlled trial with blind assessment.
Setting: Community.
Participants: PwP able to walk 100m and with no contraindication to exercise were recruited from the Thames Valley, UK, and randomized (1:1) to exercise or handwriting, via a concealed computer-generated list.
Intervention: Handwriting was undertaken at home and exercise in community facilities; both were delivered through workbooks with monthly support visits and involved practice for 1hour, twice weekly, over a period of six months.
Main measures: Handwriting was assessed, at baseline, 3, 6 and 12months, using a pangram giving writing speed, amplitude (area) and progressive reduction in amplitude (ratio). The Movement Disorder Society (MDS)-Unified Parkinson's Disease Rating Scale (UPDRS) item 2.7 measured self-reported handwriting deficits.
Results: In all, 105 pwP were recruited (analysed: n=51 handwriting, n=54 exercise). A total of 40 pwP adhered to the handwriting programme, most completing 1 session/week. Moderate effects were found for amplitude (total area: d=0.32; 95% confidence interval (CI): -0.11 to 0.7; P=0.13) in favour of handwriting over a period of12months; effects for writing speed and ratio parameters were small 0.11. Self-reported handwriting difficulties also favoured handwriting (UPDRS 2.7: odds ratio (OR)=0.55; 95% CI: 0.34 to 0.91; P=0.02). No adverse effects were reported.
Conclusion: PwP generally adhere to self-directed home handwriting which may provide benefit with minimal risk. Encouraging effects were found in writing amplitude and, moreover, perceived ability.

• 出版日期2017-12