Study Questions Physical Therapy for Early and Moderate-Stage Parkinson’s

People with early and moderate-stage Parkinson’s disease (PD) with no clear need for physical or occupational therapy who received a “low-dose” program did not see an improvement in their ability to carry out daily activities, according to research published on January 19 in the online edition of JAMA Neurology. The authors conclude that more structured and intensive physical and occupational therapy should be tested for all stages of PD, as they may be more beneficial.

The study was carried out in the United Kingdom, where the national health care system mandates that all people with PD have access to physical and occupational therapy, and where doctors routinely prescribe a low-dose program for people with mild PD (a few sessions, with limited activity).

Researchers led by Carl E. Clarke, M.D., at the West Birmingham Hospitals National Health Service Trust in Birmingham, UK, recruited 762 people with mild to moderate PD. Study participants were on average 70 years old, had been living with PD for about four and a half years and had never before received physical or occupational therapy. Participants were recruited only if they (or their care partners) reported limitations in activities of daily living, and the researcher was uncertain whether they would require physical or occupational therapy during the 15 months.

Half of the participants had hour-long visits from therapists four times over the course of two months. At the beginning of the study and three months after completion of therapy, all participants were evaluated for their ability to carry out daily activities ranging from dressing and grooming to riding public transportation.

Results

  • As measured by standard evaluation tools and questionnaires, there was no difference between the two groups in ability to carry out daily activities, or in quality of life, at the end of the three-month study.
  • There was no difference in “adverse events” — illnesses or accidents — between those who had therapy and those who did not.

What Does It Mean?

This study finds that for people with mild to moderate PD with no need for physical or occupational therapy (as decided by a clinician), low-dose short-term therapy is not beneficial. Does this mean physical therapy is not helpful in PD? No.

It is worth noting that the low-dose program prescribed does not match best practices in PD. In an editorial accompanying the study, J. Eric Ahlskog, M.D., Ph.D., of the Mayo Clinic in Rochester, MN, points out that physical therapy programs in PD can be more effective if prescribed to ease specific symptoms, such as “freezing” or balance difficulties. He also noted that past studies have proven benefits of physical therapy, such as helping people to exaggerate stride and arm swing to help compensate for stiffness and reduce risk of falls. He suggests that the therapy described in this study should incorporate aerobic exercise.

What can people with PD do? Experts agree that regular exercise is essential for maintaining mobility and flexibility. Dr. Ahlskog proposes that physical therapists could help people with PD develop and follow individualized, long-term fitness programs. Physical therapy will no doubt continue to be an important approach to coping with PD symptoms. It remains the focus of intense research and lively debate as to how it can best improve the lives of people with PD.

References

Clarke, C. E., Patel, S., Ives, N., Rick, C. E., Dowling, F., Woolley, R., et al. (2016). Physiotherapy and Occupational Therapy vs No Therapy in Mild to Moderate Parkinson Disease: A Randomized Clinical Trial. JAMA Neurology, 1–10. http://doi.org/10.1001/jamaneurol.2015.4452

Ahlskog JE. (2016). New and Appropriate Goals for Parkinson Disease Physical Therapy. JAMA Neurology, 1-2 doi:10.1001/jamaneurol.2015.4449

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