Action Imagery and Observation in Neurorehabilitation for Parkinson’s Disease (ACTION-PD): development and pilot randomised controlled trial of a user-informed home training intervention to improve everyday functional actions

ABSTRACTBackgroundParkinson’s disease (PD) causes difficulties with everyday manual activities, but few studies have addressed these therapeutically. Training with action observation (AO) and motor imagery (MI) can significantly improve performance in healthy individuals, particularly when these techniques are applied simultaneously (AO+MI). Both AO and MI have shown promising effects in PD, but previous studies have used these separately. This article describes the development and pilot testing of an intervention combining AO+MI and physical practice to improve functional manual actions in PD.MethodsThe home-based intervention, delivered using a tablet computer app, was iteratively designed by an interdisciplinary team including people with PD, and further developed through focus groups and initial testing. The intervention was then tested in a six-week randomised controlled trial (ISRCTN 11184024) of 10 participants with mild to moderate PD (6 intervention; 4 treatment as usual).Results and ConclusionsUsage and qualitative data provided preliminary evidence of acceptability and usability, indicating that a feasibility RCT is warranted. Exploratory analyses suggested potential improvements in manual actions. The importance of personalisation, choice, and motivation was highlighted, as well as the need to facilitate engagement in motor imagery. The findings also have broader relevance for AO+MI interventions in PD and other populations.IMPLICATIONS FOR REHABILITATIONParkinson’s disease affects everyday manual activities and there is a need to address these therapeutically.A home-based intervention based on combined action observation and motor imagery is acceptable and usable for people with Parkinson’s, and may improve everyday hand movements.Important considerations for interventions using observation and imagery include personalisation, choice, and motivation.Some people with Parkinson’s may need additional support to engage in motor imagery, and this should be addressed within future interventions.