Physiotherapy intervention in Parkinson's disease: systematic review and meta-analysis

Tomlinson, Claire L; Patel, Smitaa; Meek, Charmaine; Herd, Clare P; Clarke, Carl E; Stowe, Rebecca; Shah, Laila; Sackley, Catherine; Deane, Katherine; Wheatley, Keith; Ives, Natalie

doi:10.1136/bmj.e5004

Cited by 286 publications

(239 citation statements)

References 56 publications

Supporting

Mentioning

209

Contrasting

Unclassified

Order By: Relevance

“…Moreover, the increase in chronic diseases is directly related to greater functional disabilities [2]. Besides, the presence of motor dysfunction in PD increases dependence, inactivity and social isolation, factors that substantially affect the quality of life of these patients [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

“…About 1% of the population aged over 60 years develops PD, but its prevalence increases up to 4% in individuals aged 80 years or more. Thus, it has become increasingly common in countries where high rates of longevity are seen in the population [2,[4][5][6].…”

Section: Introductionmentioning

confidence: 99%

“…Complementary interventions also support and assist these therapies [10]. Physical therapy has substantial importance in maximizing motor skills, plus minimizing secondary complications arising from surgical and pharmacological therapies [5].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Feldenkrais method and functionality in Parkinson’s disease: a randomized controlled clinical trial

Teixeira-Machado

Araújo

Menezes

et al. 2016

International Journal on Disability and Human Development

View full text Add to dashboard Cite

Background: The second most common age-related chronic neurodegenerative disease after Alzheimer's disease is Parkinson's disease (PD). Objective: The focus of this study was to improve the functional capabilities of the participants with PD. Study groups: The PD participants were randomized into two groups: Feldenkrais and control. Methods: The Feldenkrais group underwent 50 sessions of an exercise program based on the Feldenkrais method. The control group received educational lectures during this period. Unified Parkinson's Disease Rate Scale (UPDRSsession III), mini-mental state evaluation (MMSE), Hoehn and Yahr scale, and functional tests (figure-of-eight walk test, timed-up-and-go test, rollover task, 360 degrees turnin-place, functional-reach test, sitting-and-standing test, Berg balance scale (BBS), and hip-flexion strength) were assessed in both groups. Procedures during the 50 sessions were conducted in an appropriate room, twice-a-week, on alternate days and lasted 60 min. Results: Thirty subjects were randomly divided into two groups: the Feldenkrais (n = 15) and the control (n = 15) group. The Feldenkrais group presented significantly better in functional tests (p < 0.05) when compared to the control group. The control group received lower scores after the

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Feldenkrais method and functionality in Parkinson’s disease: a randomized controlled clinical trial

Teixeira-Machado

Araújo

Menezes

et al. 2016

International Journal on Disability and Human Development

View full text Add to dashboard Cite

show abstract

“…Taken together, future larger and more rigorously designed studies are warranted to provide evidence on the cost‐effectiveness of the adapted HiBalance training program within clinical settings. Translating this training program into practice may offer clinicians an effective option to retrain and maintain balance and gait in persons with PD, an area that lacked proven interventions (Conradsson, Leavy, Hagströmer, Nilsson, & Franzén, 2017; Tomlinson et al., 2012). …”

Section: Discussionmentioning

confidence: 99%

“…However, the rate at which promising interventions are embedded within healthcare remains suboptimal because of challenges related to implementation (Proctor et al., 2011). The initial demands and costs to society are considerable for implementing new evidence (Krisberg, 2010) therefore, investigating feasibility aspects (e.g., process and scientific evaluation) is important for ensuring optimal uptake of interventions.…”

Section: Introductionmentioning

confidence: 99%

Implementation of the HiBalance training program for Parkinson’s disease in clinical settings: A feasibility study

et al. 2018

View full text Add to dashboard Cite

BackgroundTranslating evidence into practice requires adaptation to facilitate the implementation of efficacious interventions. A novel highly challenging balance training program (HiBalance) was found to improve gait, balance, and physical activity in persons with Parkinson’s disease (PD) in an earlier randomized controlled trial. This study aimed to describe the adaptation process and feasibility of implementing the HiBalance program for PD within primary healthcare settings.MethodFeasibility was assessed in terms of study processes and scientific evaluation. Nine persons with mild–moderate PD were enrolled in this pre–post feasibility study. The dose of the original program was adapted by reducing therapist‐led training sessions from three to two times weekly. Outcome measures were substituted with ones more clinically feasible. One group (n = 5) received HiBalance training three times weekly for 10 weeks while another (n = 4) trained twice weekly plus a once weekly home exercise program (HEP). Balance performance was the primary outcome, while secondary outcomes (e.g., gait speed, physical activity level, concerns of falling, and health‐related quality of life) were also evaluated.ResultsRegarding process feasibility, attendance was high (approximately 90%) in both groups, and experiences of the group and home training were positive. Newly selected outcome measures were feasible. The scientific evaluation revealed few adverse events and no serious injuries occurred. Concerning outcomes per group, the average change in balance performance and gait speed was equal to, or exceeded, the minimally worthwhile treatment effect commonly used in PD.ConclusionThe findings support the feasibility, in terms of process and scientific evaluation, of the adapted HiBalance program for implementation within clinical settings. A sufficiently powered study is required to ascertain whether the newly proposed program offers similar short and long‐term effects as the original program.

show abstract

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

View full text Add to dashboard Cite

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.

show abstract

Physiotherapy intervention in Parkinson's disease: systematic review and meta-analysis

Cited by 286 publications

References 56 publications

Feldenkrais method and functionality in Parkinson’s disease: a randomized controlled clinical trial

Feldenkrais method and functionality in Parkinson’s disease: a randomized controlled clinical trial

Implementation of the HiBalance training program for Parkinson’s disease in clinical settings: A feasibility study

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

Contact Info

Product

Resources

About