Parkinson’s Patients Unlikely to Benefit Greatly from Personalized Physical Therapy

Physiotherapy and occupational therapy do not improve the quality of life for patients with mild to moderate Parkinson’s disease (PD), according to a new study published in JAMA Neurology.

The findings were based on a large-scale clinical trial, PD REHAB, conducted by researchers at the University of Birmingham, U.K., to evaluate the clinical efficacy of personalized physiotherapy and occupational therapy in PD patients. The researchers reported, in a study titled “Physiotherapy and Occupational Therapy vs No Therapy in Mild to Moderate Parkinson Disease: A Randomized Clinical Trial,” that the combined therapies do not have a positive impact on “activities of daily living,” such as putting on clothes or brushing teeth, in the immediate to medium term.

Researchers suggest that more structured and intensive physical and occupational therapy programs — rather than low-dose, patient-centered ones — should be developed and tested at all stages of Parkinson disease.

“This shows that there is an urgent requirement to review current guidelines for patients with Parkinson’s disease. The resource that is committed towards these therapies, that do not appear to be effective, could be better used in  patients with more severe problems with their Parkinson’s disease,” Dr. Carl Clarke, the study’s first author, said in a news release.

“That said,” Dr Clarke added, “it is likely that increasing physical activity is beneficial for patients with earlier Parkinson’s, whether that be through dance classes or by using some of the emerging, interactive technologies that are being tested. The big challenge is to embed that behaviour long term, and to encourage more exercise over a long period of time.”

PD complicates many activities of daily living (ADL), and patients often go on to develop intractable motor problems despite treatment, as well as mental health and other non-motor complications. Physiotherapy (PT) and occupational therapy (OT) are currently recommended in the national guidelines in the United Kingdom, but are often inconsistently applied.

The clinical trial’s primary endpoint was the Nottingham Extended Activities of Daily Living (NEADL) Scale score at three months. Secondary endpoints included health-related quality of life (using the Parkinson Disease Questionnaire–39 and the EuroQol-5D), adverse events, and caregiver quality of life. The researchers assessed the trial’s outcomes at baseline and at three, nine, and 15 months after patient randomization.

A total of 762 patients with mild to moderate PD were recruited from 37 centers across the U.K. Of these, 381 received physiotherapy and occupational therapy (four, 58-minute visits over eight weeks), and 381 received no therapy. Three-month results revealed no difference between groups in NEADL total score or in the Parkinson Disease Questionnaire–39 summary index, and the EuroQol-5D quotient showed only “borderline significance” in favor of therapy.

Further, repeated-measures analysis reveals  no difference in NEADL total score, and only “small differences” favoring therapy in both quality of life measurements. There was no difference when considering adverse events.

Dr. Clarke concluded, “It is difficult to advocate the removal of something from guidelines when it was assumed to be beneficial. Though these therapies can provide marginal improvements to motor function, perhaps an extra centimetre in your stride, they don’t lead to benefits in the quality of day to day life.”

The team, which previously conducted large-scale trials on the efficacy of medical (PD MED trial) and surgical (PD SURG trial) treatments for PD, is now looking to examine the benefits of speech and language therapies (PD COMM trial) in PD patients.