Developing an occupation-based complex intervention for living well with anxiety in Parkinson's (OBtAIN-PD)

Abstract

Background: Parkinson’s is the UK's second most common neurodegenerative condition, affecting approximately 175,000 people. Current anxiolytic medications are ineffective in treating anxiety in Parkinson’s. The most promising behavioural interventions have inconclusive and mixed results. Occupational therapy is effective at promoting participation in activities of daily living and is recommended in national guidelines. An evidence-based occupational therapy intervention for living well with anxiety in Parkinson’s does not exist.

Aim: To design a new occupation-based complex intervention for living well with anxiety in Parkinson’s (OBtAIN-PD) in co-production with people with Parkinson’s (PWPs), care partners, and occupational therapists.

Methods: A scoping review, conducted in line with Joanna Briggs Institute guidance, identified what occupational therapy interventions exist for adults with anxiety and the intervention characteristics. A participatory mixed methods research study involving five stages was conducted using online Group Concept Mapping (GCM). Logic modelling was used to co-produce the OBtAIN-PD with people with Parkinson’s, carers, and occupational therapists.

Results: The scoping review included 18 studies and identified eight interventions and 31 different outcomes of current occupational therapy interventions for adults living with anxiety. Eighty-three participants took part in the GCM study. Cluster map, pattern match, and 'go-zone' charts were created using multivariate statistical analysis based on their responses. The final map contained 119 statements with eight clusters (stress value 0.252): exercise, lifestyle changes, self-help, coping, access to information, professional help, peers and groups, support from others. Significant agreement existed between the importance and feasibility rating activities (r = -0.07). ‘Go-zone’ charts highlighted the priority statements for intervention development. Thirty-two people participated in logic modelling to co-produce the OBtAIN-PD, informed by the findings of previous studies. Resources to support the new intervention (‘Inputs’) include adequate resourcing, education for professionals and people with Parkinson’s, flexibility of delivery methods, and goal setting. The intervention's actions to produce outcomes (‘Processes’) should include 1:1 support, lifestyle management, providing meaningful information, collaborative goal setting, therapeutic use of everyday activities, and involvement of friends and families. The intended outcomes should include anxiety symptom reduction, increased engagement in meaningful activities, improved understanding of anxiety and PD, better clinical outcomes, and enhanced service level outcomes. The resulting intervention manual, educational material, and training video were reviewed by five occupational therapists for content and comprehension.

Conclusion: The scoping review emphasises the necessity of using occupational therapy outcome measures, appropriate impairment-based measures, and economic evaluations for future interventions and research focused on evaluating the clinical and cost-effectiveness of occupational therapy services for individuals with anxiety. The development of the OBtAIN-PD was informed by a Group Concept Mapping study, which identified priority components. The OBtAIN-PD was co-produced with people with Parkinson’s, care partners, and occupational therapists using a logic modelling process. A protocol for a feasibility cluster randomized controlled trial is presented.