A long term self-managed handwriting intervention for people with Parkinson’s: Results from the control group of a phase II randomised controlled trial
Objective: To report on the control group of a trial primarily designed to investigate exercise for improving mobility in people with Parkinson’s Disease (pwP). The control group undertook a handwriting intervention to control for attention and time spent practising a specific activity.
Design: Secondary analysis of a two arm parallel phase II randomised controlled trial with blind assessment.
Setting: Community
Participants: PwP able to walk ≥100meters and with no contraindication to exercise recruited from the Thames valley, UK and randomised (1:1) to exercise or handwriting, via a concealed computer-generated list.
Intervention: Handwriting was undertaken at home and exercise in community facilities, both were delivered through workbooks with monthly support visits and involved practice for one hour, twice weekly, over six months.
Main measures: Handwriting was assessed, at baseline, 3, 6 and 12months, using a pangram giving writing speed, amplitude (area) and progressive reduction in amplitude (ratio). The MSD-UPDRS item 2.7 (UPDRS-2.7) measured self-reported handwriting deficits.
Results: 105 pwP were recruited (analysed: n=51 handwriting, n=54 exercise). Forty pwP adhered to the handwriting program most completing ≥1 session/week. Moderate effects were found for amplitude (total area: d=0.32 95%CI -0.11:0.7, p=0.13) in favour of handwriting over 12months, effects for writing speed and ratio parameters were small ≤0.11. Self-reported handwriting difficulties also favoured handwriting (UPDRS-2.7: OR= 0.55 95%CI 0.34:0.91, p=0.02). No adverse effects were reported
Conclusion PwP generally adhere to self-directed home handwriting which may provide benefit with minimal risk. Encouraging effects were found in writing amplitude and, moreover, perceived ability. (ClinicalTrials.Gov:NCT01439022)
