synthesis Letter

Implementation of non-pharmacological therapies improves functional mobility and quality of life in Parkinson’s disease.

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Implementation of non-pharmacological therapies improves functional mobility and quality of life in Parkinson's disease.


Parkinson's disease is a neurodegenerative condition that significantly impacts the quality of life for those influenced (Cristini et al., 2021). While pharmacological therapies play a crucial role in managing the disease, there is a developing interest in non-pharmacological therapies to complement conventional treatments. One such area of interest is the impact of physical exercises, such as boxing and sensory exercises, on the motor symptoms of Parkinson's disease. This study, conducted by Sangarapillai and colleagues in 2021, examines the potential benefits of these interventions on motor symptoms in people with Parkinson's disease (Cristini et al., 2021). This research aims to contribute to the understanding of non-pharmacological approaches in treating Parkinson's disease and to evaluate their viability in improving motor functioning and overall well-being.

Background of the study

Motor symptoms, including bradykinesia, tremors, inflexibility, and postural instability, characterize Parkinson's disease. These symptoms regularly lead to functional impairment and a diminished quality of life. While pharmacological medicines, such as levodopa, have been the pillar of Parkinson's management, they may have limitations, including side effects and reduced efficacy over time. Non-pharmacological interventions have developed as potential aides to address these limitations. One such approach includes physical exercises, including boxing and sensory exercises (Tunur et al., 2020). Studies have shown that exercises can improve balance, gait, and overall motor function in individuals with Parkinson's disease. However, there is a need for more thorough research to assess the adequacy of particular exercise interventions. In this setting, the PICO question investigates whether boxing and sensory exercises, as non-pharmacological mediations, can significantly affect motor symptoms in people with Parkinson’s (Tunur et al., 2020). The study points to supply insights that can educate the advancement of more holistic and effective management strategies for this neurodegenerative condition.

Significance of the study

Understanding the significance and importance of investigating the impact of non-pharmacological mediations, such as boxing and sensory exercises, on motor symptoms in Parkinson's disease is essential. Parkinson's disease is a weakening neurodegenerative condition affecting millions worldwide, significantly affecting their quality of life. The motor symptoms, including bradykinesia, tremors, and postural instability, frequently lead to marked limitations and loss of independence. The existing pharmacological treatments, while effective to some extent, may come with side effects and may lose efficacy over time. This highlights the need for alternative and complementary approaches to upgrade the management of this condition. Non-pharmacological interventions, like workout programs, hold promise in addressing these limitations, as they offer potential benefits for motor symptoms and overall well-being. Research in this area is significant to recognize evidence-based interventions that can improve the lives of people with Parkinson's disease and give healthcare experts more comprehensive tools for care.

Quality and Safety Education for Nurses (QSEN)

Quality and Safety education for nurses (QSEN) competencies are significant for guaranteeing that nurses give safe and high-quality care. There are six QSEN competencies, and each plays a vital role in nursing. They include patient-centered care, teamwork, quality advancement, and safety. (QSEN) competencies guarantee that nurses provide safe, high-quality care. Patient-centered care emphasizes administering medications to individual patient needs, guaranteeing responsive and personalized care that upgrades the quality of life. Teamwork and collaboration are significant for planning multidisciplinary care groups to supply complementary therapies effectively. Evidence-based practice guarantees that the choice of non-pharmacological treatments is established within the best available research, adjusting to patients' goals. Quality improvement involves ongoing assessment to upgrade the adequacy of these treatments, eventually contributing to better patient care. Safety measures are fundamental to ensure patients are protected while administering complementary services. At the same time, informatics skills help in data management to monitor patient progress and make informed care choices. These competencies collectively advance holistic, evidence-based, secure, patient-centered care in Parkinson's disease management.

Teamwork and collaboration stand at the center of providing effective and patient-centered healthcare. In the ever-evolving nursing scene, where patients frequently require care from diverse healthcare professionals, working collaboratively is not only a valuable skill but also an essential competency. For people living with chronic conditions like Parkinson's disease, a multidisciplinary approach is necessary, enveloping the skills of nurses, physical therapists, speech therapists, occupational therapists, and more. In this context, the “Teamwork and Collaboration” competency becomes fundamental in guaranteeing that care is comprehensive and harmonized. This competency goes past mere interaction; it fosters a culture of communication, mutual respect, and shared decision-making among healthcare providers to attain the highest standard of patient care. In this elaboration, we look into the importance of teamwork and collaboration, investigating how it supports quality and safety in healthcare, especially in individuals with Parkinson's disease.


Article one

Type of Research Study

The study described is a multicenter randomized controlled trial that aimed to investigate the efficacy and safety of combining electro-acupuncture with conventional pharmacotherapy for motor dysfunction and constipation in patients with Parkinson's disease (Li et al., 2023). The study included 166 patients from seven hospitals in China and used Unified Parkinson's Disease Rating Scale (UPDRS) scores and bowel frequency as dependent variables. This study used computer-generated random sequences. Statistical analyses were performed using SAS 9.4 software. The results showed that combining electro-acupuncture with conventional treatment significantly improved motor function and bowel frequency in Parkinson's disease patients. Strengths of this study include its well-designed nature, large sample size, and adherence to reporting guidelines, while limitations include a specific geographic focus and lack of a sham acupuncture group. This study provides high-quality Level I evidence for the efficacy and safety of electro-acupuncture in the treatment of Parkinson's disease (Li et al., 2023).

Purpose of Research Study

The study aimed to investigate the efficacy and safety of electro-acupuncture combined with conventional pharmacotherapy in the treatment of motor dysfunction and constipation in patients with Parkinson's disease. Li et al., (2023) conducted research using a well-designed randomized controlled trial with a sufficient sample size and provided high-quality evidence. The main research question centred on evaluating the effects of electro-acupuncture as an adjunctive therapy on motor function and bowel frequency in patients with Parkinson's disease.

Population of the Research Study

The research population in this study consisted of 166 patients diagnosed with Parkinson's disease, who were recruited from seven hospitals in China. The mean age of the patients was 63.5 years, with a majority of them being male (62.7%). The participants had an average disease duration of 5.6 years and an average Unified Parkinson's Disease Rating Scale (UPDRS) score of 32.1 at the beginning of the study (Li et al., 2023).

Methods of Research Study

The research method used in this study was a multicenter randomized controlled trial conducted in China, involving 166 patients with Parkinson's disease, and aimed to investigate the effectiveness and the safety of combining electro-acupuncture with conventional drug treatment for motor dysfunction and constipation in these patients. (Li et al., 2023). The study aimed to evaluate the effects of electro-acupuncture on motor function and bowel frequency in patients with Parkinson's disease by comparing the change in scores on the Unified Parkinson's Disease Rating Scale (UPDRS) and Frequency distribution between the electro-acupuncture group and control group after 12 weeks of treatment. This study provides valid Level I evidence, showing significant improvement in motor function and stool frequency with electro-acupuncture combined with pharmacological treatment.

Findings of the Research Study

According to Li et al. (2023), the efficacy and safety of combining electro-acupuncture with conventional pharmacological treatment were investigated in 166 patients with Parkinson's disease. The study revealed that the use of electro-acupuncture in combination with conventional pharmacological treatment significantly improved both motor function and bowel movement frequency in these patients compared to conventional treatment alone. Specifically, the mean change in Unified Parkinson's Disease Rating Scale (UPDRS) score from baseline to week 12 was significantly greater in the electro-acupuncture group (mean difference -4.2, 95% CI -6.1 to -2.3, P<0.001), and the mean change in bowel movement frequency from baseline to week 12 was also significantly greater in the electro-acupuncture group (mean difference 0.5, 95% CI 0.2 to 0.8, P=0.001). Notably, no serious adverse events were reported in either group. The study, characterized by a large sample size and rigorous methodology, provides robust Level I evidence suggesting that combining electro-acupuncture with traditional pharmacological treatment is a valuable approach to treating motor dysfunction and constipation in patients with Parkinson's disease. However, it is important to acknowledge the limitations of the study, such as the concentration on one country and the lack of a sham acupuncture group, which requires further research to clarify the specific effects of electro-acupuncture and to assess the generalizability to other populations.

Article two

Type of Research Study

Sangarapillai et al. (2021) used a double-blinded parallel-group randomized controlled trial to explore the impacts of boxing and sensory exercises on motor symptoms of Parkinson's disease. The design was characterized as an intervention study, with a sample estimate of roughly 40 members who were randomly assigned to either the boxing or sensory exercise group. This study design permitted for a thorough examination of the impact of these interventions on motor symptoms of Parkinson's disease (Sangarapillai et al., 2021).

Purpose of the Research Study

The study aims to examine the impacts of boxing and sensory exercise interventions on motor symptoms in people with Parkinson's disease. The research question rotated around evaluating the impacts of these non-pharmacological interventions, which are relevant in improving motor function and advancing social interaction among this population. This investigation, conducted at the Movement Disorders Research and Rehabilitation Center, Wildrid Laurie College, centered on the intervention groups' advance in motor symptoms, as measured by the Unified Parkinson’s Illness Rating Scale (UPDRS-III) and unbiased computerized gait data (Sangarapillai et al., 2021).

Population of the Research Study

The study's test comprised 40 participants with idiopathic Parkinson's disease, chosen from the Movement Disorders Research and Rehabilitation Center at Wildrid Laurie College. The independent variable was the type of workout interventions (boxing or sensory). In contrast, the dependent variable was motor symptoms, surveyed using the United Parkinson's Illness Rating Scale (UPDRS-III) and unbiased computerized gait data. Outstandingly, the study can be classified as Level I evidence, emphasizing its high-quality controlled trial design (Sangarapillai et al., 2021).

Methods of the Research Study

According to the study's statistical results, a double-blinded parallel-group randomized controlled trial with roughly 40 members diagnosed with idiopathic Parkinson's disease was carried out to examine the impacts of boxing and sensory exercises on motor symptoms. The statistical examinations included free t-tests to evaluate comparability, a 2-factor blended repeated-measures ANOVA to investigate the essential result degree (UPDRS-III), and repeated-measures ANOVA to examine auxiliary result measures. (Sangarapillai et al., 2021).

Findings of the Research Study

The study uncovered that both boxing and sensory exercise interventions brought about noteworthy improvements in motor symptoms of Parkinson's disease. The UPDRS-III scores have a significant primary impact on groups, with both groups showing improvement over time. The PD SAFEx group displayed more significant changes than the RSB gathered at post-assessment and washout. The study suggested the need for larger-scale trials to upgrade the generalizability of results and proposed consideration of a heart rate screen for more precise monitoring during exercises (Sangarapillai et al., 2021).


Both studies looked at non-pharmacological medications to improve motor symptoms in patients with Parkinson's disease, focusing on diverse approaches. The first study by Li e., al. (2023) looked at the combination of electro-acupuncture with conventional pharmacological treatments. On the other hand, the study by Sangarapillai et al. (2021) explored the effects of boxing and sensory exercise on motor symptoms of Parkinson's disease, and both interventions led to significant improvements in motor side effects. Both studies utilized a randomized controlled design and reported an improvement in motor symptoms. In the electro-acupuncture study, motor symptoms and bowel frequency were significantly improved compared with the control group due to the well-designed trial, large sample size, and adherence to reporting guidelines as strengths. However, the limitation of the study site in China and the lack of a sham acupuncture group raised questions about the generalizability and specificity of the intervention effect.

In contrast, the sensory training and boxing study also showed critical improvement in motor symptoms, with the PD SAFEx (sensory exercise) showing greater benefits than the RSB bunch (Boxing). This study was a well-designed double-blind randomized controlled trial with fair stride information and a washout period to survey the durability of the intervention. However, the sample size was relatively small and the participants’ diversity was limited, which may influence the generalizability of the outcome. Both studies give an important understanding of non-pharmacological approaches to managing motor symptoms in Parkinson’s disease, with each having its advantages and limitations. While electro-acupuncture may provide a more specific therapeutic intervention, boxing and sensory exercises may offer a more social and available option for patients (Sangarapillai et al., 2021; Li et al., 2023).

Nursing Practice

Implications for nursing practice

Nursing practice should prioritize a holistic care approach that addresses the varied needs of people with Parkinson's disease. This approach recognizes that the impacts of the illness expand past physical side effects and include emotional, mental, and social effects. Nurses are instrumental in advancing this holistic point of view by evaluating patients' general well-being, understanding their one-of-a-kind challenges, and planning care that manages symptoms and improves the overall quality of life. By implementing a holistic approach, nurses can assist patients and their families in coping with the emotional and psychological aspects of living with Parkinson's disease. This may include encouraging support groups, offering counselling services, and providing resources for managing depression and anxiety, which are common in Parkinson's patients. Moreover, physical treatment, workout programs, and assistive devices can improve a patient's functional independence by tending to mobility issues, a significant disease characteristic. A holistic approach, which considers the patient's physical, emotional, and social needs, is essential in improving the overall care experience for individuals with Parkinson's disease.

Best practice

Best practices within the context of Parkinson's disease and the integration of non-pharmacological complementary therapies with pharmacological treatments are based on evidence and a patient-centered approach. Multidisciplinary Care is one of the best practices to embrace. This includes collaboration between healthcare professionals such as neurologists, nurses, physical therapists, occupational therapists, speech therapists, and psychologists. These specialists work together to make an individualized care plan that addresses different perspectives of the disease. Multidisciplinary care guarantees that the patient's physical, emotional, and psychosocial needs are met successfully. Patient-Centered Care Plans is another best care practice. Each person with Parkinson's disease experiences the condition differently, hence the need to involve patients in the decision-making process. This collaborative approach empowers patients and increases their participation in their own care, ultimately leading to better outcomes and improved quality of life.

QSEN and Best practice

The best practice aligns with Qsen competency by emphasizing multidisciplinary cooperation, shared decision-making, and tailored holistic patient care. Incorporating these best practices ensures that all individuals with Parkinson's disease receive comprehensive, personalized care that considers both pharmacological and non-pharmacological therapies, leading to better management of symptoms and quality of life.

QSEN competency in nursing practice

Patient centered care impacts the care given to patients by cultivating a profound understanding of each patient's one of a kind needs, values, and preferences. This, in turn, advances the delivery of individualized and compassionate care that addresses their emotional and mental wellbeing. In addition, this approach encourages communication and collaboration among the healthcare team. By effectively including patients and their families in decision-making, medical caretakers can guarantee that care plans are comprehensive and custom fitted to meet the patient's goals and expectations, ultimately enhancing the quality of care. By recognizing the importance of Patient-Centered Care, nursing practice advances the accessibility of resources, because it underscores the significance of resource allocation based on the individualized needs. This approach empowers nurses to build strong, trusting connections with their patients, resulting in a holistic and compassionate approach to healthcare.

Nursing Education

QSEN and Educational provision

Nursing education about Parkinson's disease plays a vital role in its management. It integrates teamwork and collaboration QSEN competency through team-based learning and simulation scenarios. Practicing nurses are among the people who need to receive education. Advancing education is imperative for practicing nurses. Workshops, classes, and online courses can assist nurses to remain up to date with the most recent research and best practices in managing Parkinson's disease. This instruction should emphasize the significance of a patient-centered, multidisciplinary approach and give benefits for executing non-pharmacological treatments. Practicing nurses, including those in different healthcare settings, should be well-informed about the most recent treatment choices and be able to teach patients and their families. Nurses must also educate other individuals on the healthcare team, including physicians, physical therapists, occupational therapists, and speech specialists, about the benefits of integrating non-pharmacological therapies in Parkinson's care. Interdisciplinary collaboration is essential, and educating these professionals about the role of nursing and the potential advantages of complementary therapies is crucial in providing the best care possible.

Population to Receive Education

Patients and their families should also know about the disease and its management. Nurses should give clear, justifiable information on the disease, accessible treatment choices, and the benefits of non-pharmacological treatments, enabling patients and families with information to make a difference and effectively take an interest in decision-making and self-management, driving to better treatment and quality of life. By teaching this population, nurses can contribute to a comprehensive and patient-centered approach to Parkinson's disease care that integrates non-pharmacological therapies successfully.

Challenges in disseminating information

One critical issue in disseminating healthcare information, including information on Parkinson's disease and complementary therapies, is the presence of health challenges. Socioeconomic factors, geographic location, and systemic inequities drive these challenges. Access to quality healthcare data can be constrained for underserved and marginalized populations, resulting in unequal health outcomes. Those in low-income communities or remote areas may not have the same access to healthcare resources or educative materials, making it challenging to get convenient and essential information about managing Parkinson's disease.

Another challenge is information overload and quality assurance. In the digital age, plenty of information is available online; while this is advantageous, it also presents a challenge in information overload. Patients and caregivers may encounter overwhelming conflict or wrong data, making it troublesome to obtain reliable sources. Ensuring up-to-date information is challenging as new information is continuously emerging daily.

Recommendations for Education

One of the recommendations for providing education includes using Interactive education such as group discussions, case studies, and hands-on activities. Interactive learning can improve engagement and retention of information. Within the context of Parkinson's disease and complementary therapies, interactive sessions can allow patients and their families to ask questions, share encounters, and effectively take an interest in their care planning. These recommendations aim to make healthcare education more engaging and patient-centered.

Nursing research

Recommendations for further Research

Recommendations for further clinical and professional practice include Caregiver Education, support, and a personalized treatment plan. These recommendations point to improve the individualized and holistic care provided to Parkinson's patients and supporting the caregivers who play a critical part in their care journey.

Authors recommendations

The authors have made several proposals for the articles concerning Parkinson's disease and its management. Some of the suggestions include randomized assessment and Larger-Scale trials to address the selection bias identified in the study and give a more random and unbiased assessment program. Another proposal is an extended follow-up period and cross-cultural studies that aim to understand better Parkinson's disease and program effectiveness in different countries and cultures (Landers et al., 2019).


Cristini, J., Weiss, M., De Las Heras, B., Medina-Rincón, A., Dagher, A., Postuma, R. B., Huber, R., Doyon, J., Rosa-Neto, P., Carrier, J., Amara, A. W., & Roig, M. (2021). The effects of exercise on sleep quality in persons with Parkinson’s disease: A systematic review with meta-analysis. 
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Landers, M. R., Navalta, J. W., Murtishaw, A. S., Kinney, J. W., & Richardson, S. P. (2019). A high-intensity exercise boot camp for persons with Parkinson's disease: a phase II, pragmatic, randomized clinical trial of feasibility, safety, signal of efficacy, and disease mechanisms. Journal of Neurologic Physical Therapy, 43(1), 12-25.

Li, K., Xu, S., Wang, R., Zou, X., Liu, H., Fan, C., & Wu, H. (2023). Electro acupuncture for motor dysfunction and constipation in patients with Parkinson's disease: a randomized controlled multicentre trial. Clinical medicine, 56.

Sangarapillai, K., Norman, B. M., & Almeida, Q. J. (2021). Boxing vs sensory exercise for Parkinson’s disease: A double-blinded randomized controlled trial. Neurorehabilitation and Neural Repair, 35(9), 769-777.

Tunur, T., DeBlois, A., Yates-Horton, E., Rickford, K., & Columna, L. A. (2020). Augmented reality-based dance intervention for individuals with Parkinson’s disease: A pilot study. 
Disability and Health Journal
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