431 Physiotherapy effective for Parkinson’s disease

July 07, 2014

PEARLS 431, May 2014, written by Brian R McAvoy

Clinical question
Compared with placebo or no intervention, how effective is physiotherapy in patients with Parkinson’s disease?

Bottom line
Physiotherapy provided short term (<3 months) benefit in the treatment of Parkinson’s disease (PD). Significant benefits with physiotherapy intervention were observed for the following outcomes: 2-minute or 6-minute walk test; speed; Freezing of Gait questionnaire; Timed Up & Go test; Functional Reach Test; Berg Balance Scale; and Unified Parkinson’s Disease Rating Scale (UPDRS) total, activities of daily living and motor scores. Although most of the observed differences between the 2 treatment arms were small, the improvements seen for speed, Berg Balance Scale and UPDRS scores occurred at levels that may be considered to be of clinical importance. No difference was observed between the 2 groups in falls or patient-rated quality of life.

Caveat
The quality of the trials was not high because, in many studies, methods were not reported adequately and blinding was not feasible. Variation in measurements of outcome between studies meant analyses included only a small proportion of the participants recruited. Only 14 of the 39 trials discussed participant compliance.

Context
Despite medical therapies and surgical interventions for PD, patients develop progressive disability. Physiotherapy aims to maximise functional ability and minimise secondary complications through movement rehabilitation, within a context of education and support for the whole person. The overall aim is to optimise independence, safety and wellbeing, thereby enhancing quality of life.

Cochrane Systematic Review
Tomlinson CL et al. Physiotherapy versus placebo or no intervention in Parkinson’s disease.

Cochrane Reviews, 2013, Issue 9. Art. No.: CD002817.DOI: 10.1002/14651858. CD002817.pub4. This review contains 39 studies involving 1827 participants.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.