Parkinson’s disease is the second most common neurodegenerative disorder. It is a complex disease affecting both motor and non-motor systems in the brain. As a result patients can have a wide range of deficits in performance components, including mobility, balance, hand dexterity, memory and executive functioning. As the disease progresses, effectiveness of the medication regime often decreases, and daily functioning and social participation become increasingly compromised [1–3]. Parkinson’s disease has a great impact on the quality of life of both patients and their informal caregivers [4–6]. The costs of care are high, partly due to the increasing need of support . Improvement of quality of life and reduction of healthcare costs might be achieved by maintaining or improving the patient’s skills and independence in daily activities, and also by reducing caregivers’ burden. To address the great variety of needs in a complex and progressive disease like Parkinson’s disease, a client-centered and multidisciplinary approach is required [7–9].
Within multidisciplinary care for Parkinson patients, the primary role of occupational therapy (OT) is to optimize activity performance and engagement in valued activities and roles in the home or community context (occupational performance). The contribution of OT in Parkinson’s is widely recognized, but systematic reviews reveal a lack of rigorous studies to draw conclusions on the effectiveness of OT in Parkinson’s care [10–12]. Some studies evaluate OT as part of a multidisciplinary intervention [13–17], but the specific contribution and added value of OT cannot be determined from these studies.
From 2006 to 2008 we developed guidelines for OT in Parkinson’s disease (in Dutch), under the auspices of the Dutch Association of Occupational Therapy with the aim to improve uniformity and quality of OT in Parkinson’s disease [18, 19]. The guidelines cover specific methods for occupation-based assessment of patients and their caregivers and self-management and compensatory strategies to maintain or enhance occupational performance or occupational performance patterns in daily life.
Our hypothesis is that OT according to the Dutch guidelines has an added value within multidisciplinary care for patients with Parkinson’s disease and their caregivers. We expect that addressing the complex occupational performance issues from an OT perspective will improve daily functioning, more so than if OT is not involved. Improved daily functioning will result in enhanced participation in daily activities among patients, reduced caregiver burden, an improved quality of life for both patients and caregivers, and a reduction in costs for society. To test this hypothesis, we followed the steps of the framework for evaluation of complex interventions of the Medical Research Council [20, 21]. Based on a phase II exploratory trial  we have improved the procedures for the currently proposed randomized controlled trial (phase III trial). This trial, the OTiP study, evaluates the effectiveness and cost-effectiveness of OT according to the Dutch guidelines for OT in Parkinson’s disease.