Physiotherapy for treatment of Parkinson's disease

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Physionews24.com is keeping you updated by continuous publication on evidence based physiotherapy or related interventions to any specific disease or symptoms; in a form of summaries/abstracts from well-known systematic reviews (and/or meta-analysis) such as Cochrane Database of Systematic Reviews. Full-text article is available on request by email to the corresponding editor. Here is a recent evidence for Physiotherapy in Parkinson’s disease.

 

Physiotherapy for treatment of Parkinson’s disease

  • from Cochrane Database of Systematic Reviews

 

Authors’ conclusions:

Benefit for physiotherapy* was found in most outcomes over the short term (i.e. < 3 months) but was significant only for speed, two- or six-minute walk test, Freezing of Gait questionnaire, Timed Up & Go, Functional Reach Test, Berg Balance Scale, and clinician-rated UPDRS (the Unified Parkinson’s Disease Rating Scale). Most of the observed differences between treatments were small. However, for some outcomes (e.g. speed, Berg Balance Scale, UPDRS, the differences observed were at, or approaching, what are considered minimal clinically important changes. These benefits should be interpreted with caution because the quality of most of the included trials was not high. Variation in measurements of outcome between studies meant that our analyses include a small proportion of the participants recruited.

Background:
In spite of various medical and surgical treatments for Parkinson’s disease (PD), patients gradually develop significant physical problems. Physiotherapists aim to enable people with PD to maintain their maximum level of mobility, activity, and independence by monitoring their condition and targeting appropriate treatment. A range of approaches to movement rehabilitation are used, which aim to enhance quality of life by maximising physical ability and minimising problems related to Parkinson’s over the whole course of the disease.

Method:
Only randomised controlled trials were included in this review. In these studies,a group of participants were given physiotherapy intervention and were compared with another group of participants, who did not receive physiotherapy. Participants were assigned to a group in random fashion so a fair test was established. Thirty-nine randomised trials involving 1827 participants were identified as suitable for this review. The quality of the trials was not high because in many, methods were not reported adequately and blinding was not feasible. These trials assessed various physiotherapy interventions, so the trials were grouped according to the type of intervention being used (i.e. general physiotherapy, exercise, treadmill training, cueing, dance, or martial arts).

Results:
Improvement in all walking outcomes (except the 10- or 20-metre walk test) was noted with physiotherapy intervention. However, these improvements were significant only for walking speed, walking endurance, and freezing of gait. Mobility and balance also improved with a physiotherapy intervention, with significant improvements reported in one test of mobility (the Timed Up & Go test, which times how long it takes a person to get up from a chair, walk a certain distance, then walk back to the chair and sit down) and in two tests of balance (one assessing how far a person can reach before he or she loses balance (Functional Reach Test) and another assessing multiple aspects of balance (Berg Balance Scale)). Clinician-rated disability, using UPDRS, was also improved with physiotherapy intervention. No difference was observed between the two groups in falls or patient-rated quality of life. One study reported that adverse events were rare; no other studies reported data on this outcome. When the different physiotherapy interventions were compared, no evidence suggested that treatment effect differed across the physiotherapy interventions for any of the outcomes assessed.

NOTE
*Physiotherapy interventions include: Gait and balance exercises using verbal, auditory, and visual cues, exercises to reduce stiffness, improve muscle tone, and increase trunk rotation , Sensory attention focused exercise etc.

Reference

Tomlinson CL, Patel S, Meek C, Herd CP, Clarke CE, Stowe R, et al. Physiotherapy versus placebo or no intervention in Parkinson’s disease. The Cochrane database of systematic reviews. 2013;9:Cd002817.

Edited by

Manzur Kader, PhD researcher in Physiotherapy

Faculty of Medicine, Lund University, Sweden

Email: manzur.kader@med.lu.se