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Effectiveness of an Inpatient Multidisciplinary Rehabilitation Program for People With Parkinson Disease

T Ellis, PT, PhD, NCS, is Clinical Associate Professor, Department of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University, 635 Commonwealth Ave, Boston, MA 02215; Associate Director of Clinical Care, Center for Neurorehabilitation, Boston, Mass; and Physical Therapist and Clinical Research Scientist, Braintree Rehabilitation Hospital, Braintree, Mass.
DI Katz, MD, is Associate Professor, Department of Neurology, School of Medicine, Boston University, and Director, Brain Injury Program, Department of Neurology, Braintree Rehabilitation Hospital.
DK White, PT, ScD, NCS, is Postdoctoral Research Fellow, Clinical Epidemiology Research Training Unit, School of Medicine, Boston University.
TJ DePiero, MD, is Assistant Professor, Department of Neurology, School of Medicine, Boston University, and Medical Director, Stroke Program, Department of Neurology, Braintree Rehabilitation Hospital.
AD Hohler, MD, is Assistant Professor, Department of Neurology, School of Medicine, Boston University, and Staff Neurologist, Department of Neurology, Braintree Rehabilitation Hospital.
M Saint-Hilaire, MD, FRCPC, is Assistant Professor, Department of Neurology, School of Medicine, Boston University, and Medical Director of the Parkinson Disease Program, Department of Neurology, Braintree Rehabilitation Hospital.

tellis{at}bu.edu

Background and Purpose: In the outpatient setting, it can be difficult to effectively manage the complex medical and rehabilitation needs of people with Parkinson disease (PD). A multidisciplinary approach in the inpatient rehabilitation environment may be a viable alternative. The purposes of this study were: (1) to investigate the effectiveness of an inpatient rehabilitation program for people with a primary diagnosis of PD, (2) to determine whether gains made were clinically meaningful, and (3) to identify predictors of rehabilitation outcome.

Subjects: Sixty-eight subjects with a diagnosis of PD were admitted to an inpatient rehabilitation hospital with a multidisciplinary movement disorders program.

Methods: Subjects participated in a rehabilitation program consisting of a combination of physical therapy, occupational therapy, and speech therapy for a total of 3 hours per day, 5 to 7 days per week, in addition to pharmacological adjustments based on data collected daily. A pretest-posttest design was implemented. The differences between admission and discharge scores on the Functional Independence Measure (FIM) (total, motor, and cognitive scores), Timed "Up & Go" Test, 2-Minute Walk Test, and Finger Tapping Test were analyzed.

Results: An analysis of data obtained for the 68 subjects admitted with a diagnosis of PD revealed significant improvements across all outcome measures from admission to discharge. Subjects with PD whose medications were not adjusted during their admission (rehabilitation only) (n=10) showed significant improvements in FIM total, motor, and cognitive scores. Improvements exceeded the minimal clinically important difference in 71% of the subjects. Prior level of function at admission accounted for 20% of the variance in the FIM total change score.

Discussion and Conclusion: The results suggest that subjects with a diagnosis of PD as a primary condition benefited from an inpatient rehabilitation program designed to improve functional status.