Merging Yoga and OT for Parkinson’s Disease Improves Fatigue Management and Activity and Participation Measures

PURPOSE: Fatigue in Parkinson’s disease (PD) is a non-motor impairment often described as one of the most upsetting PD symptoms (Nassif & Pereira, 2018). Furthermore, fatigue in PD is a documented fall-risk factor (Rochester et al., 2006). Both the experience of fatigue and falling have been shown to reduce activity and participation for people with PD (Bryant et al., 2015). Yet few interventions exist to address these impairments. Therefore, the purpose of this pilot study was to explore the influence of a fall-risk management intervention, Merging Yoga and Occupational Therapy for Parkinson’s Disease (MY-OT-PD), on fatigue and activity and participation levels, as well as the relationship between these constructs.

DESIGN: This was a mixed methods pilot study incorporating a convergent parallel design to analyze quantitative and qualitative data. The 17 participants who completed the study were recruited via convenience sampling from a community based “yoga for PD” class, from a PD support group, or via flyers in the community. Inclusion criteria included: a self-reported PD diagnosis; being 18 years of age or older; scoring ≥ 4/6 on the Short Mini Mental Status Exam; having the ability to stand with or without an assistive device; having the ability to communicate in English; and having transportation to a local athletic center to participate in assessments and MY-OT-PD.

Participants completed the Modified Fatigue Impact Scale (MFIS) and the International Classification of Functioning, Disability, and Health Measure of Participation and Activities Screener (IMPACT-S) at three eight-week intervals: baseline (followed by an eight-week control period), pre-intervention (followed by MY-OT-PD), and post-intervention. Focus groups were completed at the conclusion of the intervention to qualitatively explore participants’ perception of the intervention related to their fatigue and activity and participation levels. Quantitative data were analyzed with SPSS 25 software. Analyses revealed no significant difference between baseline and pre-intervention, therefore baseline and pre-intervention data were averaged and the new mean and standard deviation were used as pre-intervention scores. Outcome measure data were analyzed for normality with a Schapiro-Wilk test and all data were normal. Paired t-tests were used to compare pre- and post-intervention scores. Furthermore, fatigue and activity and participation scores were correlated. Qualitative data were transcribed verbatim and coded using two methods: inductive and deductive coding. Inductive and deductive codes were then merged to identify themes.

RESULTS: Fatigue and activity and participation measures were significantly correlated (r=0.76). Activity and participation measures (IMPACT-S) significantly improved after the intervention (p=0.012). Four themes related to fatigue and/or activity and participation emerged following qualitative analyses including: managing fatigue: paying attention and acting accordingly; creating mindfulness in daily activities; giving and receiving within a community; and strengthening relationship to self and others.

CONCLUSION: Participants experienced improvement in activity and participation measures as well as perceived fatigue management after engagement in a community-based intervention: MY-OT-PD.

IMPACT STATEMENT: Data indicate that merging yoga and OT for people with PD may improve fatigue management and activity and participation measures. Occupational therapists (OTs) may consider educating clients on accessing community programs (including accessible yoga). OTs may also empower clients to advocate for more community programs to be created. Additionally, OTs may consider incorporating aspects of MY-OT-PD into their practice at the individual level.

References

Nassif, D. V., & Pereira, J. S. (2018). Fatigue in Parkinson’s disease: concepts and clinical approach. Psychogeriatrics, 18(2), 143-150.

Rochester, L., Jones, D., Hetherington, V., Nieuwboer, A., Willems, A.-M., Kwakkel, G., & Wegen, E. V. (2006). Gait and gait-related activities and fatigue in Parkinson’s disease: what is the relationship? Journal of Disability and Rehabilitation 28(22), 1365-1371.

Bryant, M., Rintala, D., Hou, J., & Protas, E. (2015). Relationship of falls and fear of falling to activity limitations and physical inactivity in Parkinson’s disease. European Neurology, 23(2), 187-193.