Physical Therapy in Parkinson Disease

Physiotherapy and Occupational Therapy vs No Therapy in Mild to Moderate Parkinson Disease: A Randomized Clinical Trial

Exercise

larke CE, Patel S, Ives N, et al; PD REHAB Collaborative Group
JAMA Neurol. 2016;73:291-299. [Epub ahead of print]

April 14, 2016

Study Summary

The clinical effectiveness of individualized physiotherapy and occupational therapy in Parkinson disease (PD) has previously been unclear. The open-label, parallel group, randomized PD REHAB clinical trial was therefore undertaken to assess this issue. At 38 sites across the United Kingdom between October 2009 and June 2012, 762 patients with mild to moderate PD and limitations in activities of daily living (ADL) were recruited, randomly assigned to receive either physiotherapy and occupational therapy or no therapy, and followed up for 15 months.

Mean age at study entry was 70 ± 9.1 years, and median therapist contact time was four visits of 58 minutes over 8 weeks. At study entry and at 3, 9, and 15 months after randomization, participants underwent testing with the Nottingham Extended Activities of Daily Living (NEADL) Scale score, and the Parkinson Disease Questionnaire-39 and EuroQol-5D to measure health-related quality of life. Additional outcomes included adverse events and caregiver quality of life.The primary outcome of NEADL total score at 3 months did not differ between groups (difference, 0.5 point; 95% confidence interval [CI], −0.7 to 1.7; P = .41), nor did Parkinson Disease Questionnaire-39 summary index (0.007 point; 95% CI, −1.5 to 1.5; P = .99). On the EuroQol-5D quotient, there was a minimal difference favoring therapy (−0.03; 95% CI, −0.07 to −0.002; P = .04).

Although repeated-measures analysis showed no difference in NEADL total score over time, there were small differences favoring therapy on the Parkinson Disease Questionnaire-39 summary index (diverging by 1.6 points per year; 95% CI, 0.47 to 2.62; P = .005) and EuroQol-5D score (0.02; 95% CI, 0.00007 to 0.03; P = .04). Adverse events were similar in both groups.

Viewpoint

This study is limited by a possible floor effect in NEADL score and relatively low-dose therapy, with only four visits over an 8-week period. However, the findings suggest that patient-centered, goal-directed physiotherapy and occupational therapy were not associated with immediate or medium-term clinically meaningful improvements in ADL or quality of life in mild to moderate PD.

On the basis of these results, low-dose physiotherapy and occupational therapy appear not to be justified for patients with early stage PD, but future research should investigate the efficacy and cost-effectiveness of more structured and intensive physical and occupational therapy in patients at all stages of PD.

http://www.medscape.com/viewarticle/861661?src=wnl_edit_tpal