Table 1. Summary of the studies with QOL as the primary outcome (n=18).
| Citation, Level & Quality | Purpose | Study Design | N | Setting | Outcomes and Measures | Results/Conclusions |
|---|---|---|---|---|---|---|
| Exercise intervention | ||||||
| Argolo et al. 2013 Level: II Quality: Weak | Investigate the effect of 5-week motor swallowing exercise, twice a day, 5 days a week on swallowing and QOL | Pre-test post-test evaluation | 15 | University Medical Center | Swallowing: VSS and questionnaire QOL: SWAL-QOL | VSS showed improvement in bolus control*, piecemeal swallow*, residue on the tongue*, valleculae*, and pyriform sinuses*. SWAL-QOL improved on fear* and symptom frequency*. Reduction in swallowing events not related to QOL improvements. |
| Combs et al. 2011 Level: II Quality: Weak | Compare the effects of 12-week group boxing training, 3 times a week on balance, mobility, and QOL | Case series, pretest posttest design | 6 | Community | Balance: Functional Reach Test, BBS, Activities-specific Balance Confidence Scale Gait: TUG, 6MW, GaitRite Walkway System Disability: UPDRS QOL: PDQL | Improvements in balance, gait, disability, and PDQL at 12 weeks. Improvement continued at 24 and 36 weeks. Persons with mild PD show improvements earlier than those with moderate to severe PD. |
| Combs et al. 2013 Level: I Quality: Strong | Compare the effects of 12-week, 90-min non-traditional group boxing training, 3 times a week on function and QOL | A single blinded RCT to traditional group aerobic, resistance, balance exercise | 31 | Community | Balance: BBS Balance confidence: ABC Mobility: TUG Gait velocity: GaitRite Walk way System Gait endurance: 6MWT. QOL: PDQL | Boxing significantly improved gait velocity* and endurance*. Both groups improved balance*, mobility*, and QOL [PDQL score in boxing group: median 128.0 (range 61.0) in baseline vs median 132.0 (range 63.0) in follow up]*. Traditional exercise improved balance confidence*. |
| Cruise et al. 2011 Level: I Quality: Moderate | Evaluate the benefits of 12-week exercise, twice a week on cognition, mood, and QOL | Nonrandomized controlled trial with waitlist control | 28 | Community | Cognition: MMSE, WAIS verbal IQ Depression: GDS QOL: PDQ-39 | Exercise improved executive function*, but not QOL [PDQ-39 score in exercise group: 16.4 (7.68) in baseline vs 17.9 (7.38) in follow up]. |
| Dereli, Yaliman, 2010 Level: I Quality: Weak | Compare the effect of a 10-week physiotherapist-supervised exercise program, 3 times a week with unsupervised home exercise on QOL | Non-randomized, controlled trial | 32 | Outpatient exercise unit and home | QOL: PDQL and NHP. PD Severity: UPDRS Depression: BDI | Physiotherapy-supervised exercise improved more than home exercise on PDQL/NHP total score [for PDQL, median 11(Min-2 to Max23) vs median 4(Min-16 to Max38)]** / [for NHP, median-10.5 (Min-33 to Max 0) vs median-2 (Min-13 to Max 40)]**, PDQL Parkinson's symptoms [median 5 (Min 0 to Max10) vs median 2(Min-2 to Max 16)]**, and PDQL emotional function [median 3(Min 0 to Max 6) vs median 1 (Min-7 to Max 6)]**, as well as PD severity** and depression**. |
| Dibble et al. 2009 Level: I Quality: Weak | Examine the effect of 12-week high intensity resistance exercise, 3 times a week on bradykinesia and QOL | Exercise and control groups matched on age, gender, disease severity | 20 | Movement disorders clinic | Motor deficits: UPDRS motor subscale Muscle force: MVIC Bradykinesia: TMW and TUG QOL: PDQ-39 | The exercise group improved on all measures more than the control group, including PDQ-39 [within group effect size: 0.45 in exercise vs 0.08 in control]**, TMW**, TUG**, UPDRS motor subscale, and MVIC. |
| Kelly et al. 2014 Level: II Quality: Weak | Test the effects of16-week high-intensity exercise, 3 days a week, on muscle mass, mitochondrial function, and physical capacity | Pre-test post-test design with non-PA subjects as control | 15 | University clinical exercise facility | QOL: PDQ-39, PD Severity: UPDRS Fatigue: FSS Sleep: PSQI Depression: BDI Gait: FOGBalance: single leg balance test Walking: 6MWT Thigh muscle mass: DXA | Improvements in PDQ-39 ADLs [23.1 (3.3) vs 15.6 (2.2)]*, emotional well-being [25.8 (4.5) vs 17.8(4.5)]*, and cognition [31.3 (5.4) vs 25.0 (4.6)]*. Favorable changes in skeletal muscle at cellular and sub-cellular level. |
| Pedreira et al. 2013 Level: I Quality: Strong | Evaluate the effects of 4-week 40-min Nintendo Wii training, 3 days per week on QOL | Single blinded RCT with traditional physical therapy as control | 44 | Clinic | QOL: PDQ-39 | Nintendo subjects showed greater improvements in PDQ-39 total score than control [total score in intervention group: 34.3(18.61) in baseline vs 24.2 (16.00) in follow up]*. Nintendo subjects also showed significant improvement in ADL [35.2 (24.42) vs 26.4 (22.88)]*, stigma [29.4 (28.46) vs 15.3 (19.22)]*, social support [18.2 (22.90) vs 8.3 (16.31)]*, and communication [26.0 (19.14) vs 17.3 (14.88)]* from baseline to 4 weeks. |
| Van Eijkeren et al. 2008 Level: II Quality: Weak | Test the effect of6-week Nordic walking, 2 times per week on physical inactivity and QOL | Single-group repeated measures design | 19 | Community | Functional fitness: TMW, TUG, 6MWT QOL: PDQ-39 | Nordic walking significantly improved TMW *, TUG*, 6MWT * at 6 weeks. There was a trend towards improvement for QOL (p=0.08) at 6weeks. The improvements persisted to 5-month follow-up. |
| Villegas, Israel, 2014 Level: I Quality:Weak | Analyze the effects of 12-week Ai-Chi, twice a week on functional activities, QOL, and posture | Nonrandomized controlled trial | 15 | Community | Functional activity: UPDRS QOL: PDQ-39 Posture: SAPO (a postural assessment software) | Intervention subjects showed significant improvement in functional activities* and posture*, but not QOL [PDQ-39 score in intervention group: 65.6 (20.6) in baseline vs 52.3 (21.7) in follow up]. |
| Westheimer et al. 2015 Level: I Quality: Moderate | Examine the effect of a 8-week dance intervention, twice a week on motor symptoms and QOL | Pre-test post-test design | 14 | Community | Motor: UPDRS, BBS, Depression: BDI QOL: PDQ-39 | Dance improved motor symptoms, especially gait* and tremor. QOL didn’t show significant change [PDQ-39 score in intervention group: 25.3(20.3) in baseline vs 25.1(17.6) in follow up]. |
| Yousef et al. 2009 Level: I Quality: Moderate | Investigate the effect of 10-week exercise, 4 times a week on ADL and QOL | Non-randomized, controlled trial | 24 | Rehabilitation Clinic | ADL: SPES/SCOPA QOL: PDQL | For PDQL, except for emotional functioning [21.1 (3.4) vs 21.5 (3.2)], the exercise group showed significant better scores than control in PD symptoms [48.3 (9.8) vs 38.7 (8.4)]**, systemic symptoms [21.3 (4.3) vs 16.5 (3.0)]**, social functioning [21.0 (3.3) vs 17.9 (3.2)]**, and total score [115.4 (22.3) vs 95.6 (15.6)]**. The exercise group also showed a significant better score than control in SPES/SCOPA**. |
| Acupuncture | ||||||
| Eng et al. 2006 Level: II Quality: Weak | Evaluate the safety and efficacy of 6-month combined tuina massage, acupuncture, and qi qong, weekly on QOL | Pre-test post-test design | 25 | University outpatient PD Center | Treatment response: CGI. PD Severity: UPDRS, HY ADL: SEADL Depression: BDI QOL: PDQ-39 | No significant improvements in objective measures. Some subjective improvements as based on BDI* and PDQ-39 [PDQ-39 score: 23.2 (16.4) in baseline vs 19.6 (13.9) in follow up]*. |
| Neuromuscular electrical stimulation | ||||||
| Heijnen et al. 2012 Level: I Quality: Strong | Investigate the effects of 3-5 week adjuvant neuromuscular electronical stimulation (NMES) on QOL | Double-blind RCT | 88 | Community | QOL: SWAL-QOL and MDADI Dysphagia severity: DSS | All groups showed significant improvement in DSS* and restricted positive effects on QOL with minimal group differences [Effect data of MDADI total in NMES at motor group: median 7]*. Results remained unchanged at 3 months. |
| Patient education | ||||||
| A'Campo et al. 2010 Level: I Quality: Moderate | Evaluate the effects of 8-weekly 90-minute session of Patient Education Program Parkinson (PEPP) on QOL and well-being | Double-blind RCT | 64 | University outpatientneurological department | QOL: PDQ-39 SI Depression: SDS | None of the effects were significant. However, there was a trend towards improvement for QOL [PDQ-39 SI score change: 3.1 (7.81) in PEPP vs -1.8 (6.73) in control]. |
| Reflexology | ||||||
| Johns et al. 2010 Level: II Quality: Weak | Evaluate the effect of 8 reflexology treatments on well-being | Pre-test post-test design | 16 | Community | QOL: PDQ-39 | Based on PDQ-39's mean impact over 65 weeks [average mean 3.00], improvements in PDQ-39 ADLs [mean 3.21], emotional well-being [mean 3.07], and cognition [mean 3.15], but not mobility [mean 2.79], stigma [mean2.85], social support [mean 2.64], communication [mean 2.50], and discomfort |
| Self-management program | ||||||
| Tickle-Degnen et al. 2010 Level: I Quality: Strong | Determine the effect of 18- and 27-hour self-management rehabilitation on QOL | Double-blindRCT with 0-hourself-managementrehabilitation ascontrol | 117 | Academic Parkinson Center and community | QOL: PDQ-39 | At 6 weeks, significant effect on PDQ-39 beyond best medical therapy [31.0 (SE1.1) in control vs 27.6 (SE1.1) in 18-hour]** / [31.0 (SE1.1) in control vs 27.3 (SE1.1) in 27-hour]**. No differences between 18 and 27 hours of intervention. |
| Spa therapy | ||||||
| Brefel-Courbon et al. 2003 Level: I Quality: Strong | Assess the impact of 3-week spa therapy on QOL, motor and psychological functions and cost | Single-blind | 31 | Neurological University Hospital | QOL: PDQ-39, SF-36. Motor function: UPDRS Psychological function: GHQ-28 Direct medical costs | Spa group showed significant improvement, compared to control, over 4 weeks on PDQ-39: stigma [15 (SE3) in spa vs 4 (SE3) in control]** and communication [10 (SE2) in spa vs 1 (SE3) in control]**, and onSF-36: physical health [-30 (SE7) in spa vs -5 (SE8) in control]** and mental health [-9 (SE2) in spa vs 3 (SE2) in control]**. Similar results are found on motor function**, psychological function**. Spa cost less**. |
Note: All values are mean (standard deviation) unless otherwise noted; SE=Standard Error; Min=Minimum Value; Max=Maximum Value
*
Statistically significant when compared to baseline (p< 0.05)
**
Statistically significant when comparing between groups (p< 0.05)
ABC: Activities-specific Balance Confidence; ADL: Activities of Daily Living; BBS: Berg Balance Scale; BDI: Beck Depression Inventory; CGI: Clinical Global Impression scale; DSS: Dysphagia Severity Scale; DXA: Dual energy X-ray Absorptiometry; FOG: Freezing of Gait; FSS: Fatigue Severity Scale; GHQ-28: General Health Questionnaire-28; HY: Hoehn and Yahr staging; MDADI: MD Anderson Dysphagia Inventory; MMSE: Mini-Mental State Examination; MVIC: Maximal Voluntary Isometric Force; NHP: Nottingham Health Profile; PD: Parkinson's Disease; PDQ-39: Parkinson's Disease Questionnaire-39; PDQL: Parkinson's Disease Quality of Life; PDQ-39 SI: Parkinson's Disease Questionnaire-39 Summary Index; PSQI: Pittsburgh Sleep Quality Index; RCT: Randomized Controlled Trial; SDS: Self-rating Depression Scale; SEADL: Schwab and England Activities of Daily Living scale; SF-36: Medical Outcomes Study 36-item Short Form; SPES/SCOPA: Short Parkinson Evaluation Scale/Scales for Outcomes in Parkinson's disease; SWAL-QOL: Swallowing Quality of Life; TMW: 10-meter walking test; TU1G: Timed up and go; UPDRS: Unified Parkinson's Disease Rating Scale; VSS: Videofuoroscopy of Swallowing Score; 6MWT: 6-minute walk test.