Standard vs Nonstandard Physical Therapy for Parkinson Disease: Which Is Better?

Although physical therapy (PT) is a reliable treatment option for Parkinson disease, no significant difference was found when comparing standard vs nonstandard PT, according to study findings published in JAMA Network Open.

As the fastest growing neurologic disease worldwide, progressive treatment options for Parkinson disease are of utmost importance. One facet of treatment includes PT, which aims to maintain mobility and physical function. However, there is insufficient evidence from studies investigating specific PT subtypes and their outcome effects on Parkinson disease. For the study, researchers sought to investigate a variety of PT types, as well as variables (timing, frequency, duration) and their outcomes in treating Parkinson disease.

The researchers conducted a systematic review and meta-analysis on randomized clinical trials between January 2000 and August 2022. Studies comparing PT interventions in individuals with Parkinson disease, or against a controlled group with no intervention, were included in the study. Parkinson disease characteristics (duration, baseline severity, medications, cognitive impairment), as well as PT characteristics (type, time interval, duration) were collected from each study.

A total of 46 studies were included in the systematic review, and 16 included in the meta-analysis.

Primary outcomes varied across the included trials; most common outcomes included were the Unified Parkinson’s Disease Rating Scale (UPDRS; 30%), gait (30%), and balance measures (22%).

About half of the included studies in the systematic review compared standard or conventional PT (46%) to a nonconventional PT type. Nonconventional PT was defined as any change in setting, type, intensity, or mode of delivery. Common interventions included water-based PT (11%), multidisciplinary therapy (9%), balance, resistance, or strength training (9%), and dance therapy (7%). Duration of therapy ranged from 3 weeks to 3 years, where most regimens lasted up to 12 weeks (85%).

Durability of outcome from PT was measured in trails that included a minimum of 1 follow up visit at the end of the intervention period, which was satisfied by 22 trials (48%). Of those, 17 (77%) reported improvement at the end of treatment, with 5 trials (23%) reporting worsening of outcomes after stopping PT, or that PT intervention lost durability of outcome over time.

A meta-analysis was conducted on 3 categories of outcome (gait, balance and UPDRS) when comparing nonstandard to standard PT. In reference to gait, there was no difference between nonstandard and standard PT ([standard mean difference] SMD, 0.03; 95% CI, −0.53 to 0.59). Balance and UPDRS outcomes were also found to show no difference between standard and nonstandard PT (Balance: SMD, 0.54; 95% CI, −0.03 to 1.12; UPDRS: SMD, −0.49; 95% CI, −1.04 to 0.06).

The researchers cited the exclusion of outcomes that measured quality of life and/or motor outcomes as a potential limitation. The diversity of tests used to measure outcomes was plentiful, and could potentially be interpreted as independent and specific to a clinical characteristic.

In regards to the analysis, the researchers wrote, “Our meta-analysis revealed no significant difference between standard PT and nonstandard PT for balance, gait, and UPDRS scores.” In reference to future implications, they concluded “More controlled trials and comparative effectiveness studies are needed to evaluate the risks, benefits, and durability of each type of PT intervention and to guide better implementation.”