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

Tomlinson CL, Patel S, Meek C, Herd CP, Clarke CE, Stowe R, Shah L, Sackley C, Deane KH, Wheatley K, Ives N - BMJ (2012)

Bottom Line: To assess the effectiveness of physiotherapy compared with no intervention in patients with Parkinson's disease.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).A wide range of physiotherapy techniques are currently used to treat Parkinson's disease, with little difference in treatment effects.

View Article: PubMed Central - PubMed

Affiliation: Birmingham Clinical Trials Unit, University of Birmingham, Birmingham B15 2TT, UK.

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.

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Related in: MedlinePlus

Fig 2 Review authors’ judgments about each risk of bias item, presented as percentage across all included studies
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fig2: Fig 2 Review authors’ judgments about each risk of bias item, presented as percentage across all included studies

Mentions: The amount of methodological detail reported in the trials was variable, with several quality indicators not fully discussed in many publications (fig 2, web table 2). Only six (15%) studies263233365759 reported a sample size calculation in the trial report. Less than half of the trials described the randomisation method used, and information on concealment of treatment allocation was also poorly reported (14 (36%)). Blinded assessors were used in 24 (62%) studies (although in one study, the assessors correctly guessed the treatment allocation in nearly 30% of patients33). Finally, only nine trials stated intention to treat as the primary method of analysis,293233363940475763 three trials stated per protocol as the primary method of analysis,345255 and the remaining trials did not describe the method of analysis.


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

Tomlinson CL, Patel S, Meek C, Herd CP, Clarke CE, Stowe R, Shah L, Sackley C, Deane KH, Wheatley K, Ives N - BMJ (2012)

Fig 2 Review authors’ judgments about each risk of bias item, presented as percentage across all included studies
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3412755&req=5

fig2: Fig 2 Review authors’ judgments about each risk of bias item, presented as percentage across all included studies
Mentions: The amount of methodological detail reported in the trials was variable, with several quality indicators not fully discussed in many publications (fig 2, web table 2). Only six (15%) studies263233365759 reported a sample size calculation in the trial report. Less than half of the trials described the randomisation method used, and information on concealment of treatment allocation was also poorly reported (14 (36%)). Blinded assessors were used in 24 (62%) studies (although in one study, the assessors correctly guessed the treatment allocation in nearly 30% of patients33). Finally, only nine trials stated intention to treat as the primary method of analysis,293233363940475763 three trials stated per protocol as the primary method of analysis,345255 and the remaining trials did not describe the method of analysis.

Bottom Line: To assess the effectiveness of physiotherapy compared with no intervention in patients with Parkinson's disease.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).A wide range of physiotherapy techniques are currently used to treat Parkinson's disease, with little difference in treatment effects.

View Article: PubMed Central - PubMed

Affiliation: Birmingham Clinical Trials Unit, University of Birmingham, Birmingham B15 2TT, UK.

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.

Show MeSH
Related in: MedlinePlus