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Review
. 2012 Aug 6:345:e5004.
doi: 10.1136/bmj.e5004.

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

Claire L Tomlinson  1 , Smitaa Patel, Charmaine Meek, Clare P Herd, Carl E Clarke, Rebecca Stowe, Laila Shah, Catherine Sackley, Katherine H O Deane, Keith Wheatley, Natalie Ives
Affiliations
Review

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

Claire L Tomlinson et al. BMJ. .

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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Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: support from the Department of Health for the submitted work; CEC, RS, CS, KW, and NI had support from Parkinson’s UK; SP, CM, CEC, CS, KW, and NI are either recruiting to or involved in the running of the UK PD REHAB trial.

Figures

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Fig 1 Trial flow diagram to summarise the stages of systematic review
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Fig 2 Review authors’ judgments about each risk of bias item, presented as percentage across all included studies
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Fig 3 Comparison of physiotherapy interventions in relation to speed (m/s). Studies denoted as a or b distinguishes those published by the same first author and in the same year
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Fig 4 Comparison of physiotherapy interventions with controls in relation to the timed up and go test (s). Studies denoted as a or b distinguishes those published by the same first author and in the same year
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Fig 5 Comparison of physiotherapy interventions with controls in relation to the functional teach test (cm)
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Fig 6 Comparison of physiotherapy interventions with controls in relation to the Berg balance scale. Studies denoted as a or b distinguishes those published by the same first author and in the same year
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Fig 7 Comparison of physiotherapy interventions with controls in relation to the UPDRS motor subscale. Studies denoted as a or b distinguishes those published by the same first author and in the same year
See this image and copyright information in PMC

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