Benefit Physiotherapy and Occupational Therapy in Early Parkinson Disease Questioned
No benefit seen with PT and OT in Parkinson disease.
A team of researchers from the PD REHAB Collaborative Group in England report that physical therapy (PT) and occupational therapy (OT) provide no benefit in patients with mild to moderate Parkinson disease (PD).1 Although further research is necessary to support the contention, findings from the study imply that these interventions may be time-consuming and resource-wasting in this patient population.
The study, dubbed PD REHAB, was a multicenter, open-label, parallel-group, controlled-efficacy trial that included 762 patients with mild to moderate Parkinson disease. Patients or caregivers reporting patient limitations in activities of daily living (ADL) but who had equivocal need, by clinical standards, for PT or OT in the ensuing 15 months were included in the study. Patients with dementia were excluded.
Half of the study participants were randomly assigned to PT and OT; half were not. The average duration of therapy was 8 weeks, with the median number of therapy sessions being 4 (range, 1 to 21) and each session lasting, on average, approximately one hour. ADL status, quality of life (QoL), adverse events, and caregiver QoL were assessed at baseline and at 3, 9, and 15 months. ADL status was evaluated according to the Nottingham Extended Activities of Daily Living (NEADL) Scale and QoL by the Parkinson Disease Questionnaire–39 (PDQ-39) and EuroQol-5D.
No difference in ADL scores emerged at 3 months (P = .41) or QoL as measured by the PDQ-39 (P = .99), although the EuroQol-5D slightly favored therapy (P = .04). Repeated-measures analysis over 15 months showed no difference in ADL total scores but revealed that therapy could provide a small measure of improvement in QoL over time, although improvement did not extend to mobility. No difference in adverse events was seen.
The research team, led by Carl E. Clarke, MD, of the Sandwell and West Birmingham Hospitals National Health Service Trust in Birmingham, England, acknowledged that although PT and OT have utility in patients with more severe Parkinson disease, the benefit does not appear to apply to patients with early-stage disease. At best, however, these findings suggest that blanket referrals for PT and OT in patients with early-stage Parkinson disease may be inappropriate, according to J. Eric Ahlskog, PhD, MD, professor of neurology at the Mayo Clinic in Rochester, Minnesota. Dr Ahlskog provided editorial commentary2 to the PD REHAB Collaborative Group, published online in JAMA Neurology.
“First, current physical/occupation therapy referrals for those with [Parkinson disease] should be for specific problems that are likely to benefit. Second, physical therapy practices should begin to incorporate facilitation of ongoing aerobic exercise and fitness,” he wrote, explaining that evidence exists3 to the effect that vigorous aerobic exercise may slow down Parkinson disease progression, but this evidence has yet to be applied to conventional PT strategies. He suggested that besides selective, individualized PT/OT for patients with early-stage Parkinson disease, PT should be optimized in light of emerging evidence about aerobic fitness and neuroprotection. He also called for a national campaign to promote aerobic fitness in all patients with Parkinson disease.
- Clarke CE, Patel S, Ives N, et al; for the PD REHAB Collaborative Group. Physiotherapy and occupational therapy vs no therapy in mild to moderate Parkinson disease: a randomized clinical trial. JAMA Neurol. 2016; Jan 19. [Epub ahead of print]
- Ahlskog JE. New and appropriate goals for Parkinson disease physical therapy. JAMA Neurol. 2016; Jan 19. [Epub ahead of print]
- Ahlskog JE. Does vigorous exercise have a neuroprotective effect in Parkinson disease? Neurology. 2011;77(3):288-294.