A randomized clinical trial of burst vs. spaced physical therapy for Parkinsons disease

Au, Ka Loong Kelvin; Lopes, Janine Lemos Melo Lobo Jofili; A, Kraus; Patton, Kimberly A.; Warren, Lorraine; Gao, Hanzhi; Wong, Joshua K.; Moore, Kathryn; Toledo, Jon B.; Stiep, Tamara; Frey, Jessica; Tholanikunnel, Tracy; Hess, Christopher W.; Almeida, Leonardo; Ramirez‐Zamora, Adolfo; Okun, Michael S.

doi:10.1016/j.parkreldis.2022.02.021

Cited by 10 publications

(36 citation statements)

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“…Third, we did not distinguish between intermittent and continuous AHT in our study. A recent randomized trial compared high‐frequent sessions of PT over a shorter period versus low‐frequent sessions over a longer period 24 . This complementary approach would be a promising topic for future studies to determine shorter‐ and longer‐term effects of specialized AHT on complications.…”

Section: Discussionmentioning

confidence: 99%

Specialized Versus Generic Allied Health Therapy and the Risk of Parkinson's Disease Complications

et al. 2022

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Background Specialized versus generic physiotherapy (PT) reduces Parkinson's disease (PD)–related complications. It is unclear (1) whether other specialized allied heath disciplines, including occupational therapy (OT) and speech and language therapy (S<), also reduce complications; (2) whether there is a synergistic effect among multiple specialized disciplines; and (3) whether each allied health discipline prevents specific complications. Objectives To longitudinally assessed whether the level of expertise (specialized vs. generic training) of PT, OT, and S< was associated with the incidence rate of PD‐related complications. Methods We used claims data of all insured persons with PD in the Netherlands between January 1, 2010, and December 31, 2018. ParkinsonNet‐trained therapists were classified as specialized, and other therapists as generic. We used mixed‐effects Poisson regression models to estimate rate ratios adjusting for sociodemographic and clinical characteristics. Results The population of 51,464 persons with PD (mean age, 72.4 years; standard deviation 9.8) sustained 10,525 PD‐related complications during follow‐up (median 3.3 years). Specialized PT was associated with fewer complications (incidence rate ratio [IRR] of specialized versus generic = 0.79; 95% confidence interval, [0.74–0.83]; P < 0.0001), as was specialized OT (IRR = 0.88 [0.77–0.99]; P = 0.03). We found a trend of an association between specialized S< and a lower rate of PD‐related complications (IRR = 0.88 [0.74–1.04]; P = 0.18). The inverse association of specialized OT persisted in the stratum, which also received specialized PT (IRR = 0.62 [0.42–0.90]; P = 0.001). The strongest inverse association of PT was seen with orthopedic injuries (IRR = 0.78 [0.73–0.82]; P < 0.0001) and of S< with pneumonia (IRR = 0.70 [0.53–0.93]; P = 0.03). Conclusions These findings support a wider introduction of specialized allied health therapy expertise in PD care and conceivably for other medical conditions. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

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Section: Discussionmentioning

confidence: 99%

Specialized Versus Generic Allied Health Therapy and the Risk of Parkinson's Disease Complications

et al. 2022

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“…395 patients in 7 RCT studies were included in the analysis [ 11 – 13 , 21 , 22 , 25 , 26 ]. During long-term physical therapy, the changes in the MDS-UPDRS motor score before and after using antiparkinson drugs were analyzed.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 474 patients in 9 RCT studies were included in the analysis [ 11 – 13 , 20 – 24 , 26 ]. The changes in MDS-UPDRS ADL scores before and after long-term physical therapy were analyzed to evaluate the impact of long-term physical therapy on the daily activities (ADL) of Parkinson's patients (see Figure 6 for details).…”

Section: Resultsmentioning

confidence: 99%

“…Drug Dosage (LED) of Parkinson's Patients. A total of 449 patients in 8 RCT studies were included in the analysis [11,12,20,21,[24][25][26]. Since patients used different Parkinson's drugs, levodopa equivalent dose (LED) was used for unified analysis and measurement to analyze the changes in LED dosage before and after long-term physical therapy.…”

Section: Effect Of Long-term Physical Therapy On Antiparkinsonmentioning

confidence: 99%

“…In that case, it may benefit a large number of patients. Currently, several randomized controlled trial (RCT) studies have carried out long-term physical therapy for at least 6 months or more to reveal its impact on motor symptoms, ADL, and drug dosage of PD patients [11][12][13]. Furthermore, previous studies on long-term physical therapy have primarily used various physical therapy measures, including compound aerobic exercise, strength exercise, multimodal exercise, or multidisciplinary treatment programs based on physical therapy [14].…”

Section: Introductionmentioning

confidence: 99%

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Physical Therapy for at Least 6 Months Improves Motor Symptoms in Parkinson’s Patients: A Meta-Analysis

Yang

et al. 2022

Computational and Mathematical Methods in Medicine

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Objective. Long-term physical therapy helps to improve the motor symptoms of patients with Parkinson’s disease, but the effectiveness is not clear. The purpose of this study was to evaluate the effect of long-term physical therapy on improving motor symptoms or daily activities in Parkinson’s patients with drug use or discontinuation, as well as its impact on drug treatment dose. A subgroup analysis was conducted on different treatment methods to determine the most effective treatment method. Methods. The researchers independently searched databases, including PubMed, Medline, Embase, Ovid, Cochrane Library, and ISI Web of science. The search deadline was June 2022. A randomized controlled trial was conducted on Parkinson’s disease patients with HY stages 1-3 who received continuous physical therapy for 6 months or more. Systematic evaluation and meta-analysis were carried out by using common clinical evaluation indicators, namely, MDS-UPDRS exercise score, daily activity (ADL) score, or LED dose. The quality of the literature was assessed using the modified Jadad scale of Cochrane’s bias risk tool. Results. A total of 523 Parkinson’s disease patients with HY stages of 1-3 were included in the study. The results showed that long-term physical therapy could improve patients’ motor symptoms with combined antiparkinsonian drugs ( Z = 2.61 and P = 0.009 ) and had a significant positive effect on the motor symptoms of patients with discontinued antiparkinsonian drugs ( Z = 2.73 and P = 0.006 ). Meanwhile, it could reduce the LED dose of patients with Parkinson’s disease. The difference was statistically significant ( Z = 2.58 and P = 0.010 ). Conclusion. The results of this study indicated that physical therapy for at least 6 months or longer for patients with mild to moderate Parkinson’s HY could effectively improve the motor symptoms of Parkinson’s patients, whether or not combined with antiparkinson drugs. Meanwhile, long-term physical therapy reduced the LED dose of patients treated with drugs compared with patients in the control group who received short-term physical therapy, other types of intervention group, or no treatment.

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Type, Timing, Frequency, and Durability of Outcome of Physical Therapy for Parkinson Disease

El Hayek,

Lobo Jofili Lopes,

LeLaurin

et al. 2023

JAMA Netw Open

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ImportanceParkinson disease (PD) is a neurodegenerative syndrome affecting approximately 1% of the population older than 60 years, and a major goal of treatment is preservation of physical function through physical therapy (PT). Although PT outcomes for PD are well documented, aggregate information on the parameters of PT are needed to guide implementation.ObjectiveTo evaluate current evidence on the types, timing, frequency, duration, and outcomes of PT regimens applied for PD.Data SourcesPubMed, Embase, Medline, and the Web of Science Core Collection were searched for articles published from January 1, 2000, to August 10, 2022. Search terms included terms related to Parkinson disease, PT interventions, and PT-related outcomes.Study SelectionIncluded studies were peer-reviewed randomized clinical trials available in English of any PT intervention for patients with PD that included PT-related outcomes. The Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline was followed.Data Extraction and SynthesisTwo reviewers extracted data and assessed quality using the Cochrane Risk of Bias Tool. Data were analyzed using a random-effects model.Main Outcomes and MeasuresA meta-analysis compared outcomes of nonstandard PT vs standard PT and standard PT vs no intervention for Unified Parkinson’s Disease Rating Scale (UPDRS) score and measures of gait and balance.ResultsA total of 46 trials with 3905 patients were included (range of mean ages, 61-77 years). Ten trials (22%) compared 2 types of nonstandard PT interventions; 26 (57%), nonstandard PT vs standard PT; and 10 (22%), PT vs no intervention. The most common nonconventional PT intervention was aquatic physiotherapy (5 trials [11%]). Durations of PT regimen ranged from 2 to 12 weeks in 39 trials (85%), and PT was most commonly performed with frequencies of either twice or 3 times weekly (27 [59%]). In most trials (39 [85%]), PT session length ranged from 30 to 60 minutes. Across trials, PT outcomes were reported for gait (14 trials [30%]), balance (10 [22%]), quality of life (3 [9%]), and cognition (1 [2%]). Approximately half of the trials (22 [48%]) documented durability of some level of benefit after completion of the prescribed regimen. Meta-analysis showed no significant difference for PT vs no intervention in UPDRS scores (standardized mean difference [SMD], −1.09; 95% CI, −2.50 to 0.33) or for nonstandard PT vs standard PT in measures of gait (SMD, 0.03; 95% CI, −0.53 to 0.59), balance (SMD, 0.54; 95% CI, −0.03 to 1.12), and UPDRS score (SMD, −0.49; 95% CI, −1.04 to 0.06). Meta-analytic regression of moderators revealed no significant differences in outcomes by frequency of PT per week (SMD, 0.17; 95% CI, –0.03 to 0.36).Conclusions and RelevanceThe findings suggest that although a wide range of types and regimens of PT for PD have been tested, comparative effectiveness of different models of care and implementation strategies as well as long-term durability of their outcomes remain undetermined.

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A randomized clinical trial of burst vs. spaced physical therapy for Parkinsons disease

Cited by 10 publications

References 9 publications

Specialized Versus Generic Allied Health Therapy and the Risk of Parkinson's Disease Complications

Specialized Versus Generic Allied Health Therapy and the Risk of Parkinson's Disease Complications

Physical Therapy for at Least 6 Months Improves Motor Symptoms in Parkinson’s Patients: A Meta-Analysis

Type, Timing, Frequency, and Durability of Outcome of Physical Therapy for Parkinson Disease

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