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To explore, in a European cohort of people living with Parkinson’s (PD), issues affecting employment and economic consequences, considering age at diagnosis. A cross-sectional survey (European convenience sample). Inclusion criteria were ≥18 years, a PD diagnosis and in work when diagnosed. Data were collected online on demographics, employment status, occupation, and perceived health. For those no longer in paid work, time from diagnosis until loss of employment, reasons for leaving and enablers to stay in work were ascertained. Between April and November 2019, n = 692 enrolled and n = 560 were eligible. Those who had lost paid work (n = 190, 34%) reported worse fatigue, sleep, and general health than those still in work (p < 0.05). Average annual income reduced from €26973.48 ± 12013.22 (year-1) to €14843.85 ± 16969.84 (year-10). Post-diagnosis lost employment potential was 20.1 (95% confidence interval (CI): 16.6–23.6) years at career establishment, 9.8 (95%CI: 8.9–10.7) years at mid working and 1.2 (95%CI: 0.6–1.6) years for those nearing retirement age. A greater proportion of individuals at career establishment age reported dexterity, eating, sleep, fatigue, and anxiety as factors for leaving work (p < 0.05). This study confirms lost productivity after a PD diagnosis, especially in those with many years of potential employment ahead. The study also identified potential targets for interventions. Clinical trial registration: Clincaltrials.gov (NCT03905954).Implications for rehabilitationPeople with Parkinson’s diagnosed at career establishment or at mid working age risk losing many years of potential employment.Most people with Parkinson’s do not receive early intervention to support self-management of problems identified with leaving work early, such as fatigue.Adaptations to the work environment and more flexible working patterns were identified factors that may help people remain in work. People with Parkinson’s diagnosed at career establishment or at mid working age risk losing many years of potential employment. Most people with Parkinson’s do not receive early intervention to support self-management of problems identified with leaving work early, such as fatigue. Adaptations to the work environment and more flexible working patterns were identified factors that may help people remain in work.

Objective: Evidence-based treatment for non-motor symptoms in Parkinson’s (PD) is limited. Lifestyle-based improvements including dietary changes may be a potential management strategy. To investigate the extent to which three dietary indices (Mediterranean-DASH Diet Intervention for Neurodegenerative Delay (MIND), Dietary Inflammation Index (DII), and Healthy Diet Indicator (HDI-2020) are associated with overall and individual non-motor symptom severity amongst individuals with Parkinson’s. Methods: An exploratory cross-sectional analysis of dietary (food frequency questionnaire) and clinical data, including measures of overall non-motor symptom severity, including fatigue, depression, anxiety, apathy, sleep problems, daytime sleepiness, and cognitive impairment. The relationship between each dietary score and symptom outcome were assessed by linear regression for continuous variables and through general linear model analysis for tertiles of dietary adherence. Results: None of the dietary indices significantly predicted the total non-motor symptom severity score. The HDI predicted a significant decrease in fatigue scores as measured by the NeuroQol fatigue item (standardised β= - .19, p= .022), after adjusting for age, gender, energy intake, years diagnosed, physical activity level, education, and smoking. Self-reported depression symptoms reduced by .17 (standardised β) for each unit increase in HDI score (p= .035), after controlling for age, gender, energy intake and years diagnosed. No other significant associations were evident between dietary scores and any other non-motor symptoms. Conclusion: Our results indicate that fatigue and depression in Parkinson’s may be modified by diet; however more research is needed using a larger sample to replicate these findings.

Objective: To investigate the effect of small needle-knife therapy in people with painful knee osteoarthritis. Design Pilot randomised, controlled trial. Setting. Rehabilitation hospital. Subjects. In-patients with osteo-arthritis of the knee. Interventions: Either 1-3 small needle-knife treatments over 7 days or oral Celecoxib. All patients stayed in hospital three weeks, receiving the same mobility-focused rehabilitation. Measures. Oxford Knee Score (OKS), gait speed and kinematics were recorded at baseline, at 3 weeks (discharge) and at three-months (OKS only). Withdrawal from the study, and adverse events associated with the small needle knife therapy were recorded. Results: 83 patients were randomized: 44 into the control group, of whom 10 were lost by 3 weeks and 12 at 3 months; 39 into the experimental group of whom 8 were lost at 3 weeks and 3 months. The mean (SE) OKS scores at baseline were Control 35.86 ( 1.05), Exp 38.38 ( 0.99); at three weeks 26.64 (0.97) and 21.94 (1.23); and at three months 25.83 (0.91) and 20.48 (1.14) The mean (SE) gait speed at baseline was 1.07 (0.03) m/sec (Control) and 0.98 (0,03), and at three weeks was 1.14 (0.03) and 1.12 (0.03) (p < 0.05). Linear mixed model statistical analysis showed that the improvements in the experimental group were statistically significant for total OKS score at discharge and three months. Conclusions: Small needle-knife therapy added to standard therapy for patients with knee osteoarthritis, was acceptable, safe, and reduced pain and improved global function on the Oxford Knee Score. Further research is warranted.

Supplemental material, 20-06-06_Figure_2 for The effects of small-needle-knife therapy on pain and mobility from knee osteoarthritis: a pilot randomized-controlled study by Junchen Zhu, Zhiwen Zheng, Yaomeng Liu, Sophie Lawrie, Patrick Esser, Hooshang Izadi, Helen Dawes, Zhidao Xia, Chao Wang, Yingzong Xiong, Xingfu Ma and Derick T Wade in Clinical Rehabilitation

The interplay between gender, Physical Activity (PA), and Dual Tasking (DT) in older adults is unclear. This study aimed to address DT based on gender and PA level. One-hundred and twenty older adults (81 women and 39 men) participated. Timed up and go test and spatiotemporal gait measures were collected in single and DT conditions. Participants were grouped according to gender and PA level. Physical activity did not explain gender differences, women were slower and had shorter stride lengths when DT regardless of PA level. Findings indicate the necessity for tailored PA and functional interventions to improve women’s performance.

Distribution plots showing distribution of total daily activity scores for Feedback group (A), No Feedback (control) group (B), observation group (C) and all groups (D). Table 7 shows a summary of this data at days 1, 5, 10 and 15. Red crosses indicate the mean and green squares the median. (DOCX 96 kb)

ZGPAX S8 Android Smartwatch Specifications. (DOCX 12 kb)