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1. By: Tahna Sissing
- Physiotherapy Student
Proposed Research Plan:
An evaluation of the effects of
resistance and balance training on
psychological well-being and the risk
of falls in patients with Parkinson's
disease.
2. RATIONALE OF TOPIC CHOICE
Parkinson’s Disease (PD): neurological
degenerative disorder affecting movement,
functional ability & overall quality of life
Falls & fall related injuries
leading cause of hospitalisation
in the elderly
Literature still is unclear on
effect of physical activity
intervention on falls &
psychological impact
Personal experience
3. RESEARCH QUESTION
Aging New Zealand population
more falls & fall related injuries
rising health care costs
higher prevalance of PD
What are the effects of combining resistance
training and balance training on the incidence
of falls and psychological wellbeing of patients
with Parkinson's disease?
4. Quantitative study
True experimental design using participant
randomisation & use of control group
Randomised Controlled Trial’s considered to be
‘gold standard’ for research in health sector
METHODOLOGY
5. RESEARCH DESIGN- INTERVENTION
Intervention groups
- Resistance training
- Resistance training-
balance
Control group
Double blinding procedures
6. RESEARCH DESIGN- INSTRUMENT
Balance: Berg Balance test & Timed Up & Go test
Psychological Wellbeing/ Depression: Beck
Depression Inventory
Falls: Participant kept- falls diaries/logs
7. RESEARCH DESIGN- DATA COLLECTION
Berg Balance, Timed Up & Go, Deck Depression
Inventory completed pre & post intervention
Beck Depression Inventory also completed at the
end of each month
Falls diaries checked at the end of each month
8. RESEARCH DESIGN- DATA ANALYSIS
Effect of training on muscle function and strength will be
analysed
Multivariate Analysis: analysing relationship between several
independent variables (muscle strength, balance) to seek an
explanation of the effect on the dependant variable (falls &
psychological well-being).
1) Muscle strength:
- number of repetitions x final lifted load
- percentage change pre & post intervention
2) Balance Outcome Measures:
Berg Balance Test
- score difference pre & post intervention (min 8 point difference
considered)
Timed Up & Go Test
- time difference pre & post intervention
3) Psychological Wellbeing/Depression
Beck Depression Inventory
- score difference pre & post intervention
4) Fall Rates:
- difference in number of falls 1 month prior to intervention
compared to total number of falls in the last month of intervention
9. MULTIVARIATE RELATIONSHIP: MUSCLE
STRENGTH, BALANCE OUTCOMES
Independent
Variable
Average
Changes
Resitance
Training
Resistance-
Balance
Training
Control
Muscle Strength
% Change
% % -
Berg Balance
Test Score
Differences
Timed Up & Go
Time
Differences
Beck
Depression
Inventory Score
Differences
Fall Rates
10. IMPLICATIONS FOR PROFESSIONAL/DISCIPLINE
PRACTICE OF THE RESEARCH STUDY
Add to literature
Help physiotherapist rationalise & decide on
treatment plan
Improve function, decrease risk of injury and
enhance overall quality of life for patients with
Parkinson’s disease
Editor's Notes
First I’d like to explain what PD is. PD is a neurological disorder which is degenerative and affects movement, balance and walking ability which ultimately affects everyday functional ability and their quality of life.
Because of their movement disorder and age, patients with PD are at high risk of falls & fall related injuries. According to ACC falls & fall related injuries are the leading cause of hospitalisation in the elderly. The current literature is also still unclear about the effect of resistance training on incidence of falls & its psychological impact on patients with Parkinson’s Disease. I also have a personal interest/experience a my grandfather suffers from Parkinson’s Disease.
Due to our aging New Zealand population according to Statistics New Zealand, falls and fall related injuries will be on the rise parallel with health care costs. The prevalance of PD within the community will be significant and health professionals need to intervene in order to reduce physiological deficits and improve quality of life. Other benefits would also be to decrease health care costs.
This research plan intends to complete a quantitative study and will be of true experimental design. There will be randomisation of participants and use of a control group. Randomised controlled trials are considered to be the gold standard for research in the health sector,
Participants will be placed in either an intervention group or a control group. There will be 2 intervention groups. The resistance training group will participate in increasing intensity resistance training only. This was to see if training at an impairment level, of only improving muscle strength would improve balance responses. The resistance training- balance group will receive the same resistance training and will also receive balance training which will sensory training and reactive balance training in order to improve responses to loss of balance. This intervention group was created to establish if combination of working at both impairment and strategy level, which is more functional is more beneficial to balance. The control group will not be involved in any exercise training and will continue their daily activities as normal.
To reduce bias, participants will not be aware of which group they are in. The researchers carrying out the tests and staff undertaking the training sessions will also not be aware of which group they are training or testing in order to reduce bias and the potential influence of expected outcomes.
To assess balance in the berg balance test will be used. This test was chosen because of its good correlation with other balance tests and it has been shown to be the best predictor of falls in community-dwelling older adults with neurological pathologies (Bogle-Thorbahn & Newton, 1996). The timed up and go will assess balance in a more functional setting, and is considered to be a valid tool for assessing functional ability & identifying those at risk of fall. The Beck Depression Inventory is a self rated questionnaire to measure severity of depression and shows high reliability.Incidence of falls will be recorded by participants.
It has been suggested that self-reported measures, such as the Beck Depression Inventory used in conjunction with physical function measures help complement each other with pre and post intervention comparisons and improves research validity (Kennedy & Woodhouse, 2006).
It has been suggested by (Polit & Beck, 2004) that quantitative research requires well structured data collection to produce results which will minimise bias and that are quantifiable. It also means that the results will be able to be analysed statistically.
All 3 outcomes measures will be taken pre and post intervention. The Beck Depression Inventory will also be measured after each month and falls diaries will be checked. The Beck Depression Inventory is a subjective measure, however it will produces opinion based on a scale 0-63 which can then be interpreted.
In the analysis the effect of resistance training and the combination of resistance and balance training will be analysed in relation to falls and psychological wellbeing. Multivariate analysis will be used to identify the relationship between the independent variables (muscle strength, balance) to identify its effect on the dependant variables (falls and psychological wellbeing).
-Strength gains will be measured pre & post intervention in all groups by multiplying the maximum number of repetitions completed by the final load lifted. Percentage change in muscle strength will then be calculated.
In the balance outcomes, score difference pre & post intervention will be calculated in the Beg Balance Test, keeping in mind that a minimum of 8 point difference is considered an “improvement”. Time differences will be calculated in the Timed Up & GO. - Scores in the Beck Depression Inventory will be calculated pre & post intervention and the difference in the number of falls will be compared between 1 month prior to the start of the intervention and at the end of the last month of the intervention.
From the values measured, average means can then be calculated by dividing the sum of the values of each independent variable by the total number of cases in each group. A multivariate table can then be constructed using the independent variables that were measured. Comparisons can then be made between the intervention groups & the control group.
On conclusion of this study, the results would help to add to existing information and to make it increasingly clear within the literature on how to improve balance, the incidence of falls and the impact activity has on psychological well-being. This would then help physiotherapists to rationalise and make important treatment decisions so that we as therapists can help improve function, decrease risk of injury and improve overall quality of life for Parkinson’s Disease patients.
