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Passive movement therapy in severe paratonia: a multicenter randomized clinical trial

Published online by Cambridge University Press:  20 December 2011

Johannes (Hans) S. M. Hobbelen ,
Frans E. S. Tan ,
Frans R. J. Verhey ,
Raymond T. C. M. Koopmans  and
Rob A. de Bie
Johannes (Hans) S. M. Hobbelen*
Affiliation:
Dutch Institute of Allied Health Care, Amersfoort, The Netherlands Maastricht University, Research School CAPHRI, Maastricht, The Netherlands The Maastricht Institute of Mental Health and Neurosciences/ Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands Department of Epidemiology, Maastricht University, Maastricht, The Netherlands Institute for Human Movement studies, Department of Physiotherapy, University of Applied Sciences Utrecht, The Netherlands
Frans E. S. Tan
Affiliation:
Maastricht University, Research School CAPHRI, Maastricht, The Netherlands Department of Methodology and Statistics, Maastricht University, The Netherlands
Frans R. J. Verhey
Affiliation:
The Maastricht Institute of Mental Health and Neurosciences/ Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands Maastricht University Hospital / Alzheimer Centre, Limburg, The Netherlands
Raymond T. C. M. Koopmans
Affiliation:
Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
Rob A. de Bie
Affiliation:
Maastricht University, Research School CAPHRI, Maastricht, The Netherlands Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
*
Correspondence should be addressed to: Hans Hobbelen, PhD, PT, PO Box 1161, 3800 BD Amersfoort, The Netherlands. Phone: +31-33-4216159; Fax: +31-33-4216191. Email: hobbelen@paramedisch.org and hhobbelen@iae.nl.
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Abstract

Background: Paratonia causes severe movement dysfunction in late stage dementia. Passive Movement Therapy (PMT) is often used to decrease high muscle tone, but the efficacy has never been shown. The objective of this study is to investigate the effect of PMT on muscle tone after two and four weeks of treatment.

Methods: This study comprised a multicenter single-blinded RCT. Nursing home residents with dementia (according to the DSM-IV-TR criteria) and moderate to severe paratonia were randomly assigned to either a PMT or control group. The PMT group received PMT three times a week over four weeks. The control group received no PMT. The primary outcome was the severity of paratonia as measured by the Modified Ashworth scale (MAS). Secondary outcomes were clinical change (Clinical Global Impression; CGI), caregiver's burden (modified patient specific complaints; PSC), and level of pain during morning care (Pain Assessment Checklist for Elderly with Limited Ability to Communicate, Dutch version; PACSLAC-D). All outcomes were assessed at baseline and after two and four weeks. The MAS, PACSLAC-D, and PSC data were subjected to multilevel mixed linear analysis, and the CGI data to cross-tabulation χ2 analysis.

Results: One-hundred-and-one patients from 12 Dutch nursing homes participated in the study; data from 47 patients in the PME group and 54 controls were analyzed. Patients receiving PMT performed no better in paratonia assessments, nor on CGI, PSC, or PACSLAC-D, than controls in two and four week's time.

Conclusion: PMT has no beneficial effects and should therefore not be recommended as an intervention in severe paratonia.

Trial registration: Current Controlled Trials ISRCTN43069940

Keywords

paratoniadementiapassive movement therapymovement disorders
Type
Research Article
Information
International Psychogeriatrics , Volume 24 , Issue 5 , May 2012 , pp. 834 - 844
Copyright
Copyright © International Psychogeriatric Association 2011

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