Physiotherapy ‘should be targeted’ in Parkinson’s disease

By Eleanor McDermid, Senior medwireNews Reporter

Physical and occupational therapy does not deliver quality of life (QoL) benefits for patients with mild to moderate Parkinson’s disease (PD), a randomised trial shows.

Therefore “current physical/occupation therapy referrals for those with PD should be for specific problems that are likely to benefit”, says J Eric Ahlskog (Mayo Clinic, Rochester, Minnesota, USA) in an editorial accompanying the study in JAMA Neurology.

The study included 762 patients with PD, drawn from 38 outpatient centres across the UK, who were randomly assigned to receive physiotherapy and occupational therapy or no therapy. Patients were excluded if their doctors felt they had a specific need for physical therapy.

Those in the physical/occupational therapy group received therapy according to standard National Health Service practice, undertaking a median of four sessions, lasting about an hour each, over 8 weeks.

However, this had no significant effect on patients’ Nottingham Extended Activities of Daily Living (NEADL) scores. Over the first 3 months, scores deteriorated by an average of 1.5 points in the therapy group versus 1.0 point in the control group, and there was no sign of benefit over 15 months of follow-up.

Likewise, there were no significant differences in EuroQol-5D or Parkinson Disease Questionnaire-39 (PDQ-39) between the groups at 3 months. The PDQ-39 scores of the two groups did significantly diverge over 15 months, but not to the point of a clinically meaningful difference.

This suggests “an urgent requirement to review current guidelines for patients with Parkinson’s disease”, said lead researcher Carl Clarke (University of Birmingham, UK) in a press statement. He suggested that the resources currently allocated to physical therapy for all PD patients could be better spent on tackling specific problems among those with more severe disease.

But he added: “It is difficult to advocate the removal of something from guidelines when it was assumed to be beneficial.”

In his editorial, Ahlskog asks if, instead of focusing on flexibility, gait, balance and posture, physical therapy for PD should incorporate aerobic activity, given the increasing evidence that it may slow disease progression.

He says the “substantial, albeit indirect, evidence” of the neuroprotective effects of vigorous exercise “poses the question of whether national health care administrations should endorse and financially underwrite aerobic exercise programs for all with PD.”

Clarke also suggested that patients could better benefit from increased physical activity, but added: “The big challenge is to embed that behaviour long term, and to encourage more exercise over a long period of time.”

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