In ten of these twelve participants the treatment selleck inhibitor amount was insufficient (below

60%). One participant from the experimental group was excluded because he used mental practice to relax and one because he did not reach Stage 2 of the mental practice framework. The results were similar to the intention-totreat analysis (data not shown). For the subgroup analyses, from the entire research population six participants in the mental practice group and five in the control group were excluded because they were Stage 3 or higher on the Hoehn and Yahr classification (see Table 1). Table 5 presents the results of the subgroup analysis. No significant differences were found between the two groups on any outcome measure at any point. However, except for the results of the difference score of the Timed Up and Go test at

follow-up, all measures showed more average improvement compared with baseline for the mental practice group at both measurement points. These differences were not significant. In this study, groups were comparable at baseline, but neither the intention-to-treat analysis nor the per-protocol analysis revealed any effects of mental practice on Modulators walking performance by patients with Parkinson’s disease. In the subgroup analysis of those participants with Hoehn and Yahr stages below 3, the experimental and control groups were again comparable at baseline. Although a general trend in favour of the mental practice selleck group was revealed, it was not statistically significant. Based on our power calculation, the group sizes should have been sufficient to reveal differences. Perhaps our

assumptions were too optimistic or it may have been unrealistic to expect an additional therapy incorporated into an existing treatment program to have as large an effect as we sought. Therefore the group sizes may have been too small. However, the study Tryptophan synthase by Tamir and co-workers (2007) did reveal significant effects on the Timed Up and Go test in a smaller research population (n = 23) than our total population (n = 47). The research populations were quite similar except for severity of the disease. Patients with Hoehn and Yahr stages of 3 and higher were included in our trial and may have been unable to use the techniques adequately, which might have influenced the results of the entire group. Results from the analysis of the subgroup (n = 36), whose characteristics were almost like those from the patients from the other trial, did show a general but nonsignificant trend in favour of the mental practice group. In two recent reviews there has been a call for distinction between treatments for moderately and severely affected patients (Dibble et al 2009, Kwakkel et al 2007). Mental practice might well be a treatment suitable only for patients in less severe stages of Parkinson’s disease, who are perhaps better at applying the technique.