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RCTs of Physiotherapy Interventions in Parkinson s Disease - A Systematic Review

Background. PD treatment: Pharmacological therapy SurgeryHowever, disease continues to progress, and increased disabilityPD impacts on patients mobility: Gait impairments Episodes of freezing Increased risk of fallsPhysiotherapy interventions used to: Maximise functional ability M

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RCTs of Physiotherapy Interventions in Parkinson s Disease - A Systematic Review

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    1. RCTs of Physiotherapy Interventions in Parkinson’s Disease - A Systematic Review Ms Natalie Ives 8th June 2010

    2. Background PD treatment: Pharmacological therapy Surgery However, disease continues to progress, and increased disability PD impacts on patients mobility: Gait impairments Episodes of freezing Increased risk of falls Physiotherapy interventions used to: Maximise functional ability Minimise secondary complications Through movement rehabilitation within the context of education and support for whole person Physiotherapy covers a number of different treatment techniques centred on active exercises and re-education of mobility

    3. Background In 2001, a Cochrane systematic review was published comparing physiotherapy against a placebo or no intervention for PD (Deane et al, 2001) Eleven randomised controlled trials (RCTs) were identified with 280 participants Ten trials noted a positive effect from physiotherapy, but few outcome measures were statistically significant and methodological flaws were noted Review concluded that there was insufficient evidence to support or refute the effectiveness of physiotherapy for PD Since then a number of RCTs have been published and so the review requires updating

    4. Methods - Trial Identification Literature search up to end of 2009 Systematic search for RCTs of physiotherapy versus no physiotherapy in patients with PD, sources searched: Electronic databases Trials Registers Conference proceedings Reference lists

    5. Methods - Statistics Continuous data, so extracted means and standard deviations Data abstracted independently by three authors, with any discrepancies resolved by discussion Standard meta-analysis methods Weighted mean difference Forest plots of change from baseline to end of the treatment period Investigate overall treatment effect physio treated patients compared to non-physio treated patients

    6. Methods - Statistics Wide range of approaches employed: E.g. Standard Physio, Alexander Technique, Treadmill Training, Aerobic Exercise, Tai Chi, Waltz Trials classified depending on type of physio: Physiotherapy vs. control Exercise vs. control Treadmill vs. control Cueing vs. control MDT Rehab vs. control Dance vs. control Martial Arts vs. control compared using tests of heterogeneity, both over trials & subgroups of trials

    7. Outcome Measures

    8. Results - Trials

    9. Trial Classification

    10. Results – Walking Outcomes

    11. Results – Velocity (m/s)

    12. Results – Other Physio Outcomes

    13. Results – Timed Up and Go (s)

    14. Results – Functional Reach (cm)

    15. Results – Berg Balance Scale

    16. Results – PD Outcomes

    17. Results – UPDRS ADL

    18. Results – UPDRS Motor

    19. Summary Velocity, TUG & functional reach significantly improved in physio groups Suggests improvement in functional mobility Berg balance significantly favoured intervention Positive effect on falls Falls data limited for meta-analysis UPDRS significantly favoured intervention Particularly motor symptoms Suggests improvement in PD symptoms

    20. Conclusion Updated review provides some clearer evidence on the possible benefit of physiotherapy in the treatment of PD However, most of the observed differences between treatments were small Studies included in this review are relatively small, so larger placebo controlled RCTs needed PD Rehab (n=750)

    21. Acknowledgements Claire Smith Smitaa Patel Rebecca Stowe Charmaine Meek Carl Clarke Cath Sackley Parkinson’s UK

    24. Results – PD Outcomes

    25. Results – UPDRS Total

    26. Results – UPDRS Total

    27. Results – UPDRS ADL

    28. Results – UPDRS Motor

    29. Results – PDQ-39 Summary Index

    30. Results – Multiple Arm Trials

    31. Conclusion Many different types of intervention, some have greater effect than others Physio vs. Physio review in progress Physio intervention improves functional mobility, balance, PD symptoms and QoL Evidence available supports use of physio interventions in PD Studies included in MA are relatively small, large placebo controlled RCTs needed PD Rehab

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