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European Journal of Physical and Rehabilitation Medicine 2017 February;53(1):114-24

DOI: 10.23736/S1973-9087.16.04213-1


lingua: Inglese

Towards proactive active living: patients with Parkinson’s disease experience of a multidisciplinary intensive rehabilitation treatment

Anna GIARDINI 1, Antonia PIEROBON 1, Simona CALLEGARI 1, Gabriella BERTOTTI 2, Marina MAFFONI 1, Davide FERRAZZOLI 3, 4, Giuseppe FRAZZITTA 3, 4

1 Psychology Unit, Istituti Clinici e Scientifici Maugeri, IRCCS Montescano, Montescano, Pavia, Italy; 2 Department of Neurorehabilitation, Istituti Clinici e Scientifici Maugeri, IRCCS Montescano, Montescano, Pavia, Italy; 3 Moriggia-Pelascini Hospital, Gravedona ed Uniti, Como, Italy; 4 European Foundation for Biomedical Research, S. Isidoro Hospital, Trescore Balneario, Bergamo, Italy


BACKGROUND: Non-pharmacological approaches to PD disease management seem to be a growing and promising field of investigation. Indeed interesting new perspectives are forthcoming from studies on physical rehabilitation and on physical exercise.
AIM: To qualitatively describe the rehabilitation experience of Parkinson Disease patients taking part in a multidisciplinary intensive rehabilitation treatment (MIRT) consisting of four weeks of physical therapy and exercise, with three daily sessions, five days a week.
DESIGN: Data from a qualitative observational study with patients’ interviews were analyzed.
SETTING: PD inpatients of a Neurorehabilitation Department.
POPULATION: Convenient sample of 27 PD patients (13 male, 14 female), mean age 70.3±8.5 and mean disease duration 8.25±6.9 years; Hoehn-Yahr stage 3, hospitalized for the 4-week MIRT.
METHODS: Verbatim transcriptions of 27 semi-structured interviews were analysed using the Grounded Theory methodology.
RESULTS: Depressive symptoms were present in 55.5% of the patients measured by Geriatric Depression Scale: mild (N.=8; 30.0%), moderate (N.=6; 22.2%), severe (N.=1; 3.7%). The core category Efficacy of active living identified the becoming conscious of the usefulness of a proactive lifestyle to counterattack disease degeneration. The category Satisfaction described patients’ satisfaction upon MIRT, resulting in a perceived enhanced functionality (coherently with quantitative functional parameters improvement at discharge) and a rediscovered autonomy. The category Future described the intention to continue the rehabilitation prescription at home embracing a more dynamic lifestyle. Of interest is that the majority in the interview used body related terms and described perceived changes through the body itself. Verbs of perception (to see, to feel, to perceive) were used in a spontaneous way by all inpatients. The inpatients experienced not only through their mind but also by means of body perceptions how a proactive lifestyle could become a means of disease control.
CONCLUSIONS: The positive subjective response to rehabilitation described qualitatively in this study, opens perspectives for tailoring interventions focusing also on patients’ self, self-efficacy and perceived efficacy of active living.
CLINICAL REHABILITATION IMPACT: Patients’ proactive disposition may widen the perspective on patients’ motivation to rehabilitation. A multidisciplinary intervention may act both on physical and subjective disease aspects; paying attention to patients’ subjective feedbacks could contribute reliably to guide for medical decisions in managing tailored and detailed interventions.

KEY WORDS: Parkinson disease - Neurological rehabilitation - Activities of daily living - Quality of life - Grounded theory

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