Action Plans and Their Association With Self-Management Outcomes in Parkinson’s Disease

PURPOSE: Parkinson’s disease (PD) is a chronic neurodegenerative disease associated with motor and nonmotor symptoms that negatively affect daily function and quality of life (QOL). The Chronic Disease Self-Management Program (CDSMP) is an intervention that has been implemented nationwide and has been effective in improving the QOL of people with chronic conditions. Action plans (APs), an important component of the CDSMP, are specific, achievable short-term plans to complete healthy behaviors. APs are thought to facilitate goal achievement and enhance self-efficacy, thereby contributing to improved self-management outcomes. Evidence suggests that occupational therapy interventions for people with PD should take a self-management approach, and APs have been cited as a needed component in such interventions. However, APs and their effects have not yet been studied in people with PD. Our purpose was to investigate APs developed by people with PD involved in the CDSMP and to explore the relationship of AP completion to self-management outcomes.

METHOD: Data were collected during a quasi-experimental study investigating the effects of the CDSMP for people with PD. People with mild to moderate PD without dementia were recruited from the community and the university’s movement disorders center. Eight workshops were offered from June 2013 to October 2015. Participants were placed in a CDSMP workshop on the basis of availability and location preference.

Participants in the CDSMP (2.5-hr classes 1×/wk for 6 wk) created APs at the end of each class and reported on their completion the following week. These outcomes were coded (1= completed, 0.5 = partially completed, 0 = incomplete) and then summed to get individual AP completion scores. The researchers categorized all APs into five categories: exercise, productivity, nutrition and diet, relaxation, and leisure. Questionnaires administered pre- and postintervention assessed various self-management outcomes (self-efficacy, depression, QOL, illness intrusiveness, participation, and fatigue). Descriptive statistics were calculated for AP types and completion rates, and Spearman correlations were used to analyze relationships between AP completion rates and self-management outcomes (baseline scores and 6-wk pre–post change).

RESULTS: Participants (N = 36) created a total of 138 APs: 48.6% involved exercise, 21.0% productivity, 20.3% nutrition and diet, 7.2% relaxation, and 2.9% leisure. Total AP completion (M = 3.24, SD = 1.07) correlated with baseline depression, illness intrusiveness, self-efficacy, participation, fatigue, and QOL (rs ≥ |0.36|, p ≤ .04), such that better scores on these measures related to higher AP completion. Higher total AP completion also correlated with greater improvements in self-efficacy (r = .40, p = .04). Correlations between types of APs and measures showed that exercise AP completion was associated with improvement in QOL but worsened illness intrusiveness (rs ≥ .41, p ≤ .04).

CONCLUSION: Our results indicate that, in the context of a group self-management intervention, certain characteristics (e.g., depression) may affect AP completion, but successful AP completion may contribute to improved self-efficacy and QOL in people with PD. Exercise APs were the most commonly made, which is consistent with evidence of the importance of exercise for people with PD. These findings can help guide occupational therapy practitioners to consider potential barriers to AP completion and engage in collaborative problem solving with clients to resolve these barriers. This, in turn, could increase the likelihood of successful AP completion and enhance self-management outcomes.

References

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