Abstract
Objective To assess the effectiveness of physiotherapy compared with
no intervention in patients with Parkinson’s disease.
Design Systematic review and meta-analysis of randomised controlled
trials.
Data sources Literature databases, trial registries, journals, abstract
books, and conference proceedings, and reference lists, searched up
to the end of January 2012.
Review methods Randomised controlled trials comparing physiotherapy
with no intervention in patients with Parkinson’s disease were eligible.
Two authors independently abstracted data from each trial. Standard
meta-analysis methods were used to assess the effectiveness of
physiotherapy compared with no intervention. Tests for heterogeneity
were used to assess for differences in treatment effect across different
physiotherapy interventions used. Outcome measures were gait,
functional mobility and balance, falls, clinician rated impairment and
disability measures, patient rated quality of life, adverse events,
compliance, and economic analysis outcomes.
Results 39 trials of 1827 participants met the inclusion criteria, of which
29 trials provided data for the meta-analyses. Significant benefit from
physiotherapy was reported for nine of 18 outcomes assessed. Outcomes
which may be clinically significant were speed (0.04 m/s, 95% confidence
interval 0.02 to 0.06, P<0.001), Berg balance scale (3.71 points, 2.30
to 5.11, P<0.001), and scores on the unified Parkinson’s disease rating
scale (total score −6.15 points, −8.57 to −3.73, P<0.001; activities of
daily living subscore −1.36, −2.41 to −0.30, P=0.01; motor subscore
−5.01, −6.30 to −3.72, P<0.001). Indirect comparisons of the different
physiotherapy interventions found no evidence that the treatment effect
differed across the interventions for any outcomes assessed, apart from
motor subscores on the unified Parkinson’s disease rating scale (in
which one trial was found to be the cause of the heterogeneity).
Conclusions Physiotherapy has short term benefits in Parkinson’s
disease. A wide range of physiotherapy techniques are currently used
to treat Parkinson’s disease, with little difference in treatment effects.
Large, well designed, randomised controlled trials with improved
methodology and reporting are needed to assess the efficacy and cost
effectiveness of physiotherapy for treating Parkinson’s disease in the
longer term.
Introduction
Parkinson’s disease is a complex neurodegenerative disorder1
with wide reaching implications for patients and their families.
The management of Parkinson’s disease has traditionally centred
on drug treatment,2 but even with optimal medical management,
patients still experience a deterioration of body function, daily
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