Social Prescription for Loneliness in Community-based Group Exercise Classes for People With Parkinson Disease

Parkinson's disease (PD) is a neurodegenerative condition with no known cure. Current evidence-based practice focuses on slowing disease progression, reducing negative impacts of motor and non-motor symptoms, and improving quality of life. While approaches such as exercise, medications, and surgery are used to reduce impacts of PD symptoms, there is a gap in how to address loneliness, which is a significant factor associated with poor quality of life for people with PD. Loneliness is a vast problem in the United States, the Surgeon General released a 2023 report imploring a societal focus on addressing loneliness (i.e., distressing feelings of isolation)-and people with PD have an even higher prevalence of loneliness than the general population. Occupational therapists play a key role in addressing the loneliness epidemic for people with PD. Social participation is one of eight categories of occupation elucidated in the Occupational Therapy (OT) Practice Framework. Yet, limited OT guidelines exist on how to address the occupation of social participation. According to the 2022 OT Clinical Practice Guidelines for people with PD, moderate evidence exists for community-based group activity. Considering OT as a discipline focused on using occupation both as a means (training using social participation), and as an ends (reduction of loneliness), investigators should be on the forefront of evidence-based practice to address loneliness. Group format, community-based exercise is one approach with potential for addressing loneliness. Parkinson Association of the Rockies (PAR) offers 70+ weekly community-based group exercise classes in Colorado and surrounding states. For over two years, the investigators have been partnering with PAR to collect outcomes data of PAR exercise class participants in areas of psychosocial outcomes (e.g., loneliness), mobility, and quality of life. Interestingly, over one third of individuals with PD who are participating in the PAR group exercise classes self-report to be in the 'lonely' range (3-item UCLA Loneliness Scale [UTILS] score =5/9). After reviewing evidence-informed strategies to address loneliness, the investigators found a clear method already developed-social prescription. Social prescription offers a method to improve loneliness through further community connection in an individualized, meaningful way.

Evidence-based Practice to Address Loneliness

The process of social prescription is standardized, requiring identification into the program by a health professional or community member (e.g., PAR staff), evaluation with a coordinator (e.g., OT), and partnerships with local organizations (e.g., PAR). The investigators developed a preliminary resource manual to identify resources within each of the 11 interventions recommended within social prescription (e.g., intergenerational intervention, animal companions, physical activity, occupational therapy), and use an occupational profile to identify the individualized target area for each participant. The approach will follow the Grol & Wensing Implementation Process model in which the investigators have already completed Steps 1-3 (identifying the topic for change, analysis of sample/site, selection of strategies to address change). Now in steps 4&5 of the model, the investigators will implement social prescription with one organization, and then evaluate to adapt prior to scaling up to multiple organizations, with the following two aims:

Aim 1. Determine the reach of OT-led social prescription for people with Parkinson's disease using a single-site pilot trial.

Aim 2. Evaluate the OT-led social prescription for people with Parkinson's disease for a signal of effectiveness using a single-site pilot trial.