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

Hans Hobbelen, Frans Tan, Frans Verhey, Raymond Koopmans, Rob de Bie

Research output: Contribution to journalArticleAcademicpeer-review

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
Original languageEnglish
Pages (from-to)834-844
JournalInternational psychogeriatrics
Volume24
Issue number5
DOIs
Publication statusPublished - Dec 2011

Keywords

  • paratonia

Cite this

Hobbelen, Hans ; Tan, Frans ; Verhey, Frans ; Koopmans, Raymond ; de Bie, Rob. / Passive movement therapy in severe paratonia : a multicenter randomized clinical trial. In: International psychogeriatrics. 2011 ; Vol. 24, No. 5. pp. 834-844.
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Passive movement therapy in severe paratonia : a multicenter randomized clinical trial. / Hobbelen, Hans; Tan, Frans; Verhey, Frans; Koopmans, Raymond; de Bie, Rob.

In: International psychogeriatrics, Vol. 24, No. 5, 12.2011, p. 834-844.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Passive movement therapy in severe paratonia

T2 - a multicenter randomized clinical trial

AU - Hobbelen, Hans

AU - Tan, Frans

AU - Verhey, Frans

AU - Koopmans, Raymond

AU - de Bie, Rob

PY - 2011/12

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N2 - 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

AB - 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

KW - paratonie

KW - dementie

KW - paratonia

U2 - 10.1017/S1041610211002468

DO - 10.1017/S1041610211002468

M3 - Article

VL - 24

SP - 834

EP - 844

JO - International psychogeriatrics

JF - International psychogeriatrics

SN - 1041-6102

IS - 5

ER -