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Education for people with progressive neurological conditions can have negative effects: Evidence from a randomized controlled trial

G Turpin

Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK

M E Dewey

Trent Institute for Health Services Research, University of Nottingham, Nottingham, UK

S Fleming

Division of Rehabilitation and Ageing, University of Nottingham; Trent Strategic Health Authority, University of Nottingham, Nottingham, UK

B Hurwitz

Department of Primary Health Care and General Practice, Imperial College, London; Department of English Language and Literature, King's College London, Nottingham, UK

S Ratib

Trent Institute for Health Services Research, University of Nottingham, Nottingham, UK

M von Fragstein

Division of Primary Care, University of Nottingham, Nottingham, UK

M Lymbery

School of Sociology and Social Policy, University of Nottingham, Nottingham, UK

Objectives: To test the effects of a home-based educational intervention in reducing the incidence and the risk of falls and pressure sores in adults with progressive neurological conditions.

Design: Randomized controlled trial with 12 months follow-up.

Setting: Participants’ homes in the City of Nottingham.

Participants: One hundred and fourteen people with progressive neurological conditions recruited from general practices in Nottingham, including 53 with Parkinson's disease and 45 with multiple sclerosis.

Interventions: In the education group (EG), baseline data were reviewed by an expert panel which advised on actions most likely to promote each individual's physical, social and psychological well-being. An occupational therapist (OT) then visited EG participants to provide education and information and to discuss a personalized 12-month health action plan. The comparison group (CoG) received standardized printed information delivered to their home.

Main measures: Numbers of participants reporting falls and skin sores at two-monthly phone calls during the follow-up period of 12 months.

Results: The EG reported significantly more falls during the follow-up period and at 12 months (adjusted odds ratio 2.83 (95% CI 1.07-7.47), p=0.036) and significantly more skin sores (adjusted odds ratio 12.74 (95% CI 1.14-142.6), p=0.039) than the CoG. There was no difference between CoG and EG in the Nottingham Extended Activities of Daily Living score, but EG patients showed a significant rise in this score over the study period of 1.62 (95% CI 0.69-2.55, p=0.002).

Conclusions: Our findings provide evidence that education for people with progressive neurological conditions can have negative effects.

Clinical Rehabilitation, Vol. 18, No. 7, 717-725 (2004)
DOI: 10.1191/0269215504cr792oa


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