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Physiotherapy for patients with Parkinson's Disease: a comparison of techniques.

Abstract

BACKGROUND

Despite optimal medical and surgical therapies for Parkinson's disease, patients develop progressive disability. The role of the physiotherapist is to maximise functional ability and minimise secondary complications through movement rehabilitation within a context of education and support for the whole person.

OBJECTIVES

To compare the efficacy and effectiveness of physiotherapy with placebo or no interventions in patients with Parkinson's disease.

SEARCH STRATEGY

Relevant trials were identified by electronic searches of MEDLINE, EMBASE, CINAHL, ISI-SCI, AMED, MANTIS, REHABDATA, REHADAT, GEROLIT, Pascal, LILACS, MedCarib, JICST-EPlus, AIM, IMEMR, SIGLE, ISI-ISTP, DISSABS, Conference Papers Index, Aslib Index to Theses, the Cochrane Controlled Trials Register, the CentreWatch Clinical Trials listing service, the metaRegister of Controlled Trials, ClinicalTrials.gov, CRISP, PEDro, NIDRR and NRR; and examination of the reference lists of identified studies and other reviews.

SELECTION CRITERIA

Only randomised controlled trials (RCT) were included, however those trials that allowed quasi-random methods of allocation were allowed.

DATA COLLECTION AND ANALYSIS

Data was abstracted independently by KD and DJ and differences settled by discussion.

MAIN RESULTS

Eleven trials were identified with 280 patients. Eight trials did not have adequate placebo treatments, all used small numbers of patients and the method of randomisation and concealment of allocation was good in only four trials. These methodological problems could potentially lead to bias from a number of sources. Although ten of the trials claimed a positive effect from physiotherapy, few outcomes measured were statistically significant. Walking velocity was measured in four trials and increased significantly in two of them. Stride length was the only other outcome measured in more than one trial, it was significantly improved in two trials. Five other outcomes improved significantly in individual studies, but eight other outcomes did not improve significantly.

REVIEWER'S CONCLUSIONS

Considering the methodological flaws in many of the studies, the small number of patients examined, and the possibility of publication bias, there is insufficient evidence to support or refute the efficacy of physiotherapy in Parkinson's disease. The studies illustrate that a wide range of approaches are being employed by physiotherapists to treat Parkinson's disease. This was confirmed by the UK survey of physiotherapists. There is a need to develop a consensus as to 'best-practice'. Large well designed placebo-controlled RCTs are then needed to demonstrate the efficacy and effectiveness of 'best practice' physiotherapy in Parkinson's disease. The stage of the disease at which the physiotherapy is given should be specified at the outset. Outcome measures with particular relevance to patients, carers, physiotherapists and physicians should be chosen and the patients monitored for at least six months to determine the duration of any beneficial effects. The trials should be reported according to CONSORT guidelines.

Authors+Show Affiliations

Department of Neurology, City Hospital NHS Trust, Dudley Road, Birmingham, West Midlands, UK, B18 7QH. c.e.clarke@bham.ac.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review
Systematic Review

Language

eng

PubMed ID

11687029

Citation

Deane, K H., et al. "Physiotherapy for Patients With Parkinson's Disease: a Comparison of Techniques." The Cochrane Database of Systematic Reviews, 2001, p. CD002817.
Deane KH, Jones D, Playford ED, et al. Physiotherapy for patients with Parkinson's Disease: a comparison of techniques. Cochrane Database Syst Rev. 2001.
Deane, K. H., Jones, D., Playford, E. D., Ben-Shlomo, Y., & Clarke, C. E. (2001). Physiotherapy for patients with Parkinson's Disease: a comparison of techniques. The Cochrane Database of Systematic Reviews, (3), CD002817.
Deane KH, et al. Physiotherapy for Patients With Parkinson's Disease: a Comparison of Techniques. Cochrane Database Syst Rev. 2001;(3)CD002817. PubMed PMID: 11687029.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Physiotherapy for patients with Parkinson's Disease: a comparison of techniques. AU - Deane,K H, AU - Jones,D, AU - Playford,E D, AU - Ben-Shlomo,Y, AU - Clarke,C E, PY - 2001/11/1/pubmed PY - 2002/3/29/medline PY - 2001/11/1/entrez SP - CD002817 EP - CD002817 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 3 N2 - BACKGROUND: Despite optimal medical and surgical therapies for Parkinson's disease, patients develop progressive disability. The role of the physiotherapist is to maximise functional ability and minimise secondary complications through movement rehabilitation within a context of education and support for the whole person. OBJECTIVES: To compare the efficacy and effectiveness of physiotherapy with placebo or no interventions in patients with Parkinson's disease. SEARCH STRATEGY: Relevant trials were identified by electronic searches of MEDLINE, EMBASE, CINAHL, ISI-SCI, AMED, MANTIS, REHABDATA, REHADAT, GEROLIT, Pascal, LILACS, MedCarib, JICST-EPlus, AIM, IMEMR, SIGLE, ISI-ISTP, DISSABS, Conference Papers Index, Aslib Index to Theses, the Cochrane Controlled Trials Register, the CentreWatch Clinical Trials listing service, the metaRegister of Controlled Trials, ClinicalTrials.gov, CRISP, PEDro, NIDRR and NRR; and examination of the reference lists of identified studies and other reviews. SELECTION CRITERIA: Only randomised controlled trials (RCT) were included, however those trials that allowed quasi-random methods of allocation were allowed. DATA COLLECTION AND ANALYSIS: Data was abstracted independently by KD and DJ and differences settled by discussion. MAIN RESULTS: Eleven trials were identified with 280 patients. Eight trials did not have adequate placebo treatments, all used small numbers of patients and the method of randomisation and concealment of allocation was good in only four trials. These methodological problems could potentially lead to bias from a number of sources. Although ten of the trials claimed a positive effect from physiotherapy, few outcomes measured were statistically significant. Walking velocity was measured in four trials and increased significantly in two of them. Stride length was the only other outcome measured in more than one trial, it was significantly improved in two trials. Five other outcomes improved significantly in individual studies, but eight other outcomes did not improve significantly. REVIEWER'S CONCLUSIONS: Considering the methodological flaws in many of the studies, the small number of patients examined, and the possibility of publication bias, there is insufficient evidence to support or refute the efficacy of physiotherapy in Parkinson's disease. The studies illustrate that a wide range of approaches are being employed by physiotherapists to treat Parkinson's disease. This was confirmed by the UK survey of physiotherapists. There is a need to develop a consensus as to 'best-practice'. Large well designed placebo-controlled RCTs are then needed to demonstrate the efficacy and effectiveness of 'best practice' physiotherapy in Parkinson's disease. The stage of the disease at which the physiotherapy is given should be specified at the outset. Outcome measures with particular relevance to patients, carers, physiotherapists and physicians should be chosen and the patients monitored for at least six months to determine the duration of any beneficial effects. The trials should be reported according to CONSORT guidelines. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/11687029/Physiotherapy_for_patients_with_Parkinson's_Disease:_a_comparison_of_techniques_ L2 - https://doi.org/10.1002/14651858.CD002817 DB - PRIME DP - Unbound Medicine ER -