Early rehabilitation linked to longer survival in Parkinson’s, study suggests
Delaying rehab raised mortality risk regardless of disability level
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- Parkinson's disease involves the progressive loss of dopamine-producing neurons, leading to motor symptoms.
- Starting rehabilitation within the first year of a Parkinson's diagnosis may be linked to longer survival.
- Delaying rehabilitation is associated with a progressively higher risk of mortality across all disability levels.
Starting rehabilitation within the first year after a Parkinson’s disease diagnosis may be associated with longer survival, even among people who had already developed disability, a nationwide South Korean study found.
Delaying rehabilitation was associated with progressively higher mortality risk across all disability levels, including among people without functional impairment.
Researchers said these findings “indicate that the survival benefit of timely rehabilitation is not confined to the pre-disability stage; even among individuals with functional impairment, the prompt initiation of rehabilitation therapy remains meaningfully associated with improved long-term outcomes.”
The study, “Timing of rehabilitation therapy initiation and all-cause mortality in parkinson’s disease: nationwide cohort study,” was published npj parkinson’s disease.
Rehabilitation an important part of long-term Parkinson’s care
Parkinson’s is caused by the progressive loss of dopaminergic neurons, nerve cells that produce dopamine, a signaling molecule involved in movement. This leads to motor symptoms, such as tremors, slow movements, and balance and gait problems.
While medications can ease symptoms, they do not stop the disease from progressing, making rehabilitation an important part of long-term care. Guidelines recommend starting rehabilitation early, although in practice this is often delayed until people develop walking or balance problems. Whether starting rehabilitation early can affect patients’ long-term outcomes, including survival, remains unclear.
To learn more, researchers in South Korea used national health insurance data to examine whether the timing of rehabilitation after a Parkinson’s diagnosis was associated with the risk of death, and whether this association differed according to disability severity.
Survival better among those who started rehab within year of diagnosis
The study included 19,153 people with Parkinson’s, of whom 10,393 (54.3%) started rehabilitation two years or more after being diagnosed, 6,170 (32.2%) within one year of diagnosis, and 2,590 (13.5%) between one and two years following diagnosis.
Those who began rehabilitation within the first year of being diagnosed were more likely to be women and had a higher burden of coexisting conditions, including high blood pressure, abnormal levels of fatty molecules in the blood, urinary tract infections, and depression, than those who started rehabilitation later. They were also more likely to smoke and reported lower levels of physical activity.
During follow-up, which lasted up to 15 years, 11,339 participants (59.2%) died. After adjusting data for patients’ age, sex, income level, and other variables, investigators found that people who started rehabilitation one to two years after being diagnosed with Parkinson’s had a 28% higher risk of death than those who began rehabilitation within the first year of diagnosis. Those who waited at least two years had a 44% higher risk.
Systematic efforts to facilitate early rehabilitation referral at the time of PD diagnosis are warranted to improve long-term survival outcomes.
Further survival analyses also showed significantly better survival among people who started rehabilitation within the first year of diagnosis.
After adjusting data for potential confounding factors, researchers found that people who had mild to moderate disability at the time they started rehabilitation had a 21% higher risk of death than those without functional impairment, while those with severe disability had a 45% higher risk.
The researchers then examined whether the timing of rehabilitation remained associated with mortality within each disability group. Among people without disability at the start of rehabilitation, those who began rehabilitation one to two years after diagnosis had a 25% higher risk of death compared with those who started rehabilitation within the first year of diagnosis. Those who waited at least two years had a 46% higher risk.
A similar pattern was seen among people with mild to moderate or severe disability. In all three groups, longer delays in starting rehabilitation were consistently associated with a higher mortality risk.
Researchers noted that rehabilitation is often initiated only after functional decline has set in, describing this as a “reactive rather than proactive approach” to Parkinson’s management.
In their view, the findings support incorporating rehabilitation referral into routine care at the time of diagnosis, rather than waiting for gait, balance, or other functional problems to emerge.
“Systematic efforts to facilitate early rehabilitation referral at the time of PD diagnosis are warranted to improve long-term survival outcomes,” they wrote.
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