Can group therapy be as effective as individual physical therapy for persons with Parkinson’s disease (PD)?

Answer:  Yes, if it is the RIGHT class!

There is growing evidence that working in groups is beneficial for people with PD for motivational reasons, accountability, emotional and psychological support, and for socialization (among other things).  Since we started group exercise classes at [re+active], we were curious about whether a patient doing group therapy could actually improve function or would participation just help them maintain at the same level (or just slow progression since it is a neurodegenerative disease!).  So we decided to test our hypothesis in a patient case and see.

We created our [re+move] High Intensity Parkinson’s Exercise class to target specific problems that people with Parkinson’s disease have, such as difficulties with balance, walking, turning, agility, coordination, functional movement, bradykinesia, and stiffness.  We put this all into one fun group class set to music!  The time frame for this trial class was 1 time per week for 12 weeks.  As the class progressed each week, we could see the changes in the participants.  They were walking better, standing taller and they were happier!  They were becoming friends and confidants for each other.   However, we still weren’t sure whether there would be a change in the actual outcomes.

One patient (patient X) in the group had been working individually with Dr. Hershberg and I one time per week since June 2012, and we had been doing regular assessments on him throughout his program.  He decided to transition from the individual sessions for a while and join the group class in June 2013, a year after starting individual PT and 5 years after his diagnosis.  The bout of classes was followed by a couple of reassessment therapy sessions to ensure he was maintaining good function and not having any new problems.

During individual PT sessions, patient X displayed negative feelings and poor self-efficacy.   He struggled to commit to exercise outside of therapy sessions and had difficulty seeing his improvements despite objective improvements in outcome measures.  Once he joined the group class, however, his demeanor changed and the improvements became noticeable both to him and to his family members.  He gained more confidence in himself and engaged in more activities in his social life.  He began coming to therapy without his walker and would smile and joke more often.  It was wonderful to see an improved quality of life and we were eager to see whether there would be changes in the outcome measures as well.  What more could you ask for?!  When we reassessed him after the group sessions ended, not only were his scores better than at the last re-assessment – they were better than they were 1 year prior!  I thought: this is pretty incredible; he has a neurologic condition that is supposed to make him worse, and therapy may only make him maintain, but instead he is BETTER now than he was 1 year ago!  Hurray for physical therapy!

We are now even more firm believers that the group class can change lives and actually improve the function of people with degenerative diseases – not just maintain function!  You just can’t discount the impact that emotional health has on our bodies and our function.  Doing targeted and individual therapy is very beneficial, but sometimes adding that other dimension that only the group can add is really the ticket to success.

Try it yourselves and see!  What successes have you guys had with groups?

Outcome Measure for patient X

	6/25/12	3/5/13	7/12/13	8/16/13
Gait Velocity (10 m walk)	0.77 m/s, with Front Wheeled Walker	1.0 m/s, no assistive device	1.11 m/s, no assistive device	1.0 m/s, no assistive device
Timed up and Go (TUG)	9.45 sec	9.08 sec	7.23 sec	7.9 sec
TUG cognitive	15.27 sec, no errors	12.78 sec, no errors	11.44 sec, no errors	10.44 sec, no errors
5x Sit to Stand	15.92 sec	14.3 sec	6.95 sec	6.93 sec
Exercise Self Efficacy Scale	NT	0%	80%	80%
Falls	1 in 2 months	1 per 6 weeks	1 every other month	None in 2 months