Effectiveness of Intensive Inpatient Rehabilitation Treatment on Disease Progression in Parkinsonian Patients

Frazzitta, Giuseppe; Bertotti, Gabriella; Riboldazzi, Giulio; Turla, Marinella; Uccellini, Davide; Boveri, Natalia; Guaglio, Gabriele; Perini, Michele; Comi, Cristoforo; Balbi, Pietro; Maestri, Roberto

doi:10.1177/1545968311416990

Cited by 102 publications

(153 citation statements)

References 36 publications

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“…Scheduled yearly hospitalizations in rehabilitation inpatient centers are becoming fewer owing to financial constraints. Inpatient rehabilitation facilities have been becoming increasingly available only after major deterioration into a parkinsonian crisis secondary to causes such as a stroke, major surgery, severe pneumonia, and falls and associated fracture, as well as acute confusion or psychosis [18].…”

Section: Inpatient Facilitymentioning

confidence: 99%

Interdisciplinary Teamwork for the Treatment of People with Parkinson’s Disease and Their Families

Giladi

Manor

Hilel

et al. 2014

Curr Neurol Neurosci Rep

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Parkinson's disease (PD) is a chronic progressive neurodegenerative and multidimensional disease that involves a range of disabling motor and nonmotor symptoms. These symptoms can have a major impact on the quality of life of PD patients. The focus of this article is to stress the importance of the interdisciplinary team intervention approach in the treatment of patients with PD. The team approach uses experts in PD from different health care professions, including a neurologist, a nurse, a speech and language therapist, a physiotherapist, a social worker, a psychiatrist, an occupational therapist, a sexologist, and a dietician. The major aim of the team and of teamwork is to provide professional care in all motor and nonmotor aspects of PD throughout the course of the disease. There are different models of multidisciplinary teams: inpatient facility, community rehabilitation facility, and synchronized multiprofessional treatment in the community. The Tel Aviv Sourasky Medical Center model of interdisciplinary care was designed to create a coordinated multidisciplinary team in the Movement Disorders Unit. The role of each team member and their professional objective are described. Their collaboration is by design a promotion of a team goal for maintaining and enhancing the quality of life of PD patients and their families.

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Section: Inpatient Facilitymentioning

confidence: 99%

Interdisciplinary Teamwork for the Treatment of People with Parkinson’s Disease and Their Families

Giladi

Manor

Hilel

et al. 2014

Curr Neurol Neurosci Rep

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“…The study by Frazzitta and colleagues 41 reported sustained benefits at 1 year from a highdose 4-week in-patient programme, with a repeat intervention delivered at follow-up just as effective. A further high-quality RCT, by Schenkman et al, 64 found improvements in walking economy persisted to 16 months follow-up.…”

Section: Sustainabilitymentioning

confidence: 99%

“…There is some evidence that an in-patient rehabilitation programme has benefits in the short- 40,41 and long-term 41 for people with PD. However, financial constraints and the judicious use of in-patient hospital beds, 42,43 in addition to an increased focus on the provision of more patient-centred care, 44 has shifted the focus from in-patient to AR for the management of chronic diseases.…”

Section: Rehabilitation Settingmentioning

confidence: 99%

“…71 In a RCT, Frazzitta and colleagues 41 offered the same frequency of therapy to a group of in-patients with PD over 4 weeks, for a total of 60 hours of therapy. They reported improvements in performance of motor tasks and activities of daily living (ADL), compared with a control group who performed unsupervised generic exercise.…”

Section: Dosementioning

confidence: 99%

“…Most clinical trials are performed on patients with mild to moderate disease (stages I-III), 40,41,62,64,72,74 with few including patients with more severe disease (stage IV). 36,37,48 Treatment goals may be very different for patients depending on their disease severity 28 and thus, the current evidence may not be applicable to those patients with advanced PD.…”

Section: Staging and Patient Selectionmentioning

confidence: 99%

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Evaluation and delivery of ambulatory rehabilitation for people with Parkinson's disease

Goodwin

Lan

2014

Rev. Clin. Gerontol.

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SummaryParkinson's disease (PD) is a common and costly condition affecting a predominantly older population. Physical rehabilitation has been shown to enhance motor performance and functional mobility in the shortterm. However, there is limited information available about how best to design and deliver an ambulatory rehabilitation (AR) programme for this patient group. This article reviews the current evidence, aiming to provide guidance about best-practice service provision. We highlight the benefits of group therapy and techniques aimed at reducing falls. Further research is required to determine the optimal dose and intensity of AR necessary to provide sustained benefits in people with different stages of PD.

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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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Effectiveness of Intensive Inpatient Rehabilitation Treatment on Disease Progression in Parkinsonian Patients

Abstract: These findings suggest that the natural worsening of symptoms associated with PD can be effectively counteracted by a properly designed IRT.

Cited by 102 publications

References 36 publications

Interdisciplinary Teamwork for the Treatment of People with Parkinson’s Disease and Their Families

Interdisciplinary Teamwork for the Treatment of People with Parkinson’s Disease and Their Families

Evaluation and delivery of ambulatory rehabilitation for people with Parkinson's disease

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

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