PATIENT EDUCATION AND HEALTH PROMOTION CAN BE EFFECTIVE IN PARKINSONS-DISEASE - A RANDOMIZED CONTROLLED TRIAL

We performed a randomized controlled trial to evaluate the effectivene ss of a patient education and health promotion program in the treatmen t of Parkinson's disease. The health promotion program (PROPATH) was d esigned to improve hearth confidence, provide information and support, improve physical function through exercise, and work with the physici an to optimize medical treatment and compliance. The intervention was delivered by mail, with disease assessment questionnaires completed by patient or caregiver at 0, 2, 4, and 6 months, with computer-generate d reports and individualized recommendation letters returned to patien ts and reports to physicians. Two hundred ninety patients completed th e 6-month trial, 140 patients in the intervention group and 150 in a c ontrol group of patients who received only questionnaires. The interve ntion group had significantly increased exercise, decreased ''time off '' and percentage of time off, reduced side effects, and decreased sum mary Parkinson's scores by approximately 10% (P >0.05). Twelve of 13 v ariables showed differences favoring the intervention group. The rate of progression of summary scores became essentially flat during the pr ogram for the intervention group and continued to rise sharply for con trols (P >0.01). Levodopa dose rose for controls and slightly decrease d for the intervention group. Doctor visits, hospital days, and sick d ays were reduced in the intervention group. The quality-of-life assess ment demonstrated improvement in patient global, self-efficacy scores, and spouse or caregiver assessments. We conclude that a low-cost pati ent education program provides a useful adjunct to medical therapy of Parkinson's disease, may reduce costs, and can improve intermediate te rm outcomes.