Systematic Review And Meta-Analysis of Clinical Effectiveness of Self-Management Interventions In Parkinson’s

IntroductionParkinson’s is a complex neurodegenerative condition with significant impact on quality of life (QoL), wellbeing and function. This review evaluates the clinical effectiveness of self-management interventions for people with Parkinson’s, taking a broad view of self-management and considering effects on QoL, wellbeing and function.MethodsSystematic database searches were conducted for studies evaluating self-management interventions for people with Parkinson’s. Articles were independently reviewed by two reviewers, data extracted and synthesised through a narrative approach and meta-analysis for sufficiently similar studies. Interventions were broken down into self-management components using the PRISMS Taxonomy.Results36 studies were included, encompassing a range of study designs and evaluating a diverse array of interventions. Risk of bias was moderate to high for the majority of studies, mostly due to lack of participant blinding, which is not often practical for interventions of this nature. Four studies report significant improvements in QoL, wellbeing or functional outcomes for the intervention compared to controls. These interventions were group-based self-management education and training programmes, either alone, combined with multi-disciplinary rehabilitation, or combined with Cognitive Behaviour Therapy; and a self-guided community-based exercise programme. A meta-analysis could be conducted on four RCTs of self-management education and training programmes evaluating QoL, demonstrating no significant difference between the self-management and the control groups (p=0.38). Components more common in the RCTs with effective interventions and in those showing pre-post intervention improvement were: information about resources; training or rehearsing psychological strategies; social support; and lifestyle advice and support.ConclusionApproaches and outcomes to self-management interventions in Parkinson’s are heterogenous. There are insufficient high quality RCTs in this field to show effectiveness of self-management interventions in Parkinson’s. Whilst it is not possible to draw conclusions on specific intervention components that convey effectiveness, there are promising findings from some studies, which could be targeted in future evaluations.