Testing the feasibility and impact of the restorative care-PD intervention on the older adult with Parkinson's disease and their caregivers

Abstract

Background. Over time individuals with PD lose their ability to navigate through their environment, communicate, and perform self care tasks such as eating, dressing, and toileting. The decrease in ability of the PD patient to care for their basic needs is often left to family members who must find ways to deal with day to day care situations. Caregivers often are untrained and unsure of what type of care or how much care they should provide to their family member, leaving them frustrated and burdened. Design. This pilot study is a single group, two pre-test, one post-test repeated measures design to investigate the feasibility and impact of a Res-Care-PD intervention specifically designed for the community-dwelling individual with PD and their caregiver. Intervention. Res-Care-PD, is a self-efficacy based restorative care intervention utilizing a two-tiered approach with the intent of teaching and motivating caregivers to engage in restorative care activities and then to help them motivate PD individuals to engage in functional activities and exercise. The intervention involved one two-hour home visit and four follow-up phone calls by an advanced practice nurse trained in restorative care.;Results. The impact of Res-Care PD on the individual with PD showed a statistically significant increase in exercise outcome expectations (F=4.59, p=0.015); functional performance on Barthel Index (F=11.2, p<0.001), independence on Schwab & England (F=10.31, p=0.001); decreased disability on Unified Parkinson Disease Rating Scale total ( F=13.3, p=0.001); time in physical activity (YPAS; F=5.91, p=0.001), particularly hours in exercise (YPAS; F=10.6, p=0.002), and a trend towards significance for exercise self-efficacy (F=3.04, p=0.058). There were no significant changes noted for functional performance self-efficacy or outcome expectations, chair rise times, or depressive symptoms. Caregivers showed a significant increase in knowledge of restorative care (F=3.95, p=0.026), but no changes in restorative care efficacy beliefs, depression scores, Zarit or CSI burden scores. Conclusions. Res-Care PD could easily be implemented in the home setting and had a significant effect on increasing caregiver knowledge about restorative care techniques and on strengthening outcome expectations related to exercise, time spent in exercise and physical activity and in improving functional performance in individuals with PD.