What is the effectiveness of physiotherapy intervention compared with no intervention in patients with Parkinson's disease?
TYPE OF REVIEW
This is a Cochrane review of 33 randomized controlled trials with 1,518 participants; meta-analyses were undertaken where possible.
RELEVANCE FOR NURSING
Despite various available medical and surgical treatments, patients with Parkinson's disease continue to face increased deterioration of body function and difficulties with activities of daily living. There has been increasing support for the inclusion of rehabilitation therapies as an adjuvant to pharmacologic and neurosurgical treatments. Physiotherapy aims to maximize functional ability and minimize secondary complications through movement rehabilitation. Nurses on the multidisciplinary team can make a significant contribution to positive outcomes in these patients.
CHARACTERISTICS OF THE EVIDENCE
The mean age of participants in the 33 trials was 67 years, 64% were male, and patients had Parkinson's disease for about six years. Thirty trials had a parallel design and three had a crossover design. In each trial, participants given physiotherapy were compared with controls (those not given physiotherapy or given placebo). Most trials looked at the short-term effect of therapy by assessing the participants at baseline and immediately or shortly after the intervention period (which ranged from three to 52 weeks). Trials were grouped by type of intervention used: general physiotherapy, exercise, treadmill training, cueing, dance, or martial arts. Outcome measures included gait (using the two- or six-minute walk test and walking speed, for example), functional mobility and balance (using the Timed Up and Go test, the Functional Reach Test, and the Berg Balance Scale, for example), patient falls, clinician-rated impairment and disability (using the Unified Parkinson's Disease Rating Scale [UPDRS], for example), and patient-rated quality of life.
Compared with no intervention, physiotherapy significantly improved the gait outcomes of velocity, the two- or six-minute walk test, and step length; the functional mobility and balance outcomes of the Timed Up and Go test, the Functional Reach Test, and the Berg Balance Scale; and clinician-rated disability using the UPDRS, as well as the activities of daily living and motor subscales of the UPDRS. There was no difference between the intervention and control arms in falls or patient-rated quality of life. Indirect comparisons of the different interventions found no evidence that the treatment effect differed across interventions for any of the outcomes assessed.
BEST PRACTICE RECOMMENDATIONS
This review provides evidence of the short-term benefit of physiotherapy in the treatment of patients with Parkinson's disease. Most observed differences between treatments were small, although for some (velocity, the Berg Balance Scale, and the UPDRS, for example) observed differences were of or approaching minimal clinical importance. The question of whether physiotherapy has any long-term benefit remains unanswered, as does which type of physiotherapy intervention to use. Further evidence is needed before conclusions can be reached on these issues.
The majority of trials in this review were small and had a short follow-up period; therefore, large randomized controlled trials of longer duration are needed. There is also a need for trials that examine more specific, improved treatment strategies to identify the most appropriate choice of physiotherapy and confirm the validity of the outcomes measured.
Tomlinson CL, et al. Physiotherapy versus placebo or no intervention in Parkinson's disease. Cochrane Database Syst Rev 2012;8:CD002817.