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Physical therapy not associated with improvements in patients with early stages of Parkinson's disease

The JAMA Network Journals

For patients with mild to moderate Parkinson disease (PD) there were no clinically meaningful benefits to activities of daily living or quality of life associated with physiotherapy and occupational therapy in a study conducted in the United Kingdom, according to an article published online by JAMA Neurology.

PD causes problems with activities of daily living (ADL) that are only partially treated by medication and occasionally surgery. Physiotherapy (PT) and occupational therapy (OT) have been traditionally used later in the disease.

Carl E. Clarke, M.D., of the University of Birmingham, England, and coauthors conducted a large clinical trial to evaluate the effectiveness of PT and OT in 762 patients with mild to moderate PD who were recruited from 38 sites across the United Kingdom. The participants had limitations in ADL and were randomly assigned to PT and OT (n= 381 patients) or no therapy (n=381). The primary outcome was ADL score after three months and secondary outcomes were quality of life ratings. The median number of therapy sessions was four with an average time of 58 minutes per session over eight weeks.

At three months, the study notes no difference between the groups in ADL total score or on a health-related quality of life questionnaire summary index.

The authors note it is possible that mild to moderate disease may not respond to therapies, whereas more severe disease may respond, "although this remains to be established," according to the results.

"Physiotherapy and OT using an individual goal-setting approach produced no clinically meaningful short- or medium-term benefits in ADL or QoL [quality of life] in patients with mild to moderate PD. This evidence does not support the use of low-dose, goal-directed PT and OT in patients in the early stages of PD. Future research should explore the development and testing of more structured and intensive PT programs in patients with all stages of PD," the study concludes.

(JAMA Neurol. Published online January 19, 2016. doi:10.1001/jamaneurol.2015.4452. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor's Note: The study includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Editorial: New, Appropriate Goals for Parkinson Disease Physical Therapy

"These results should be interpreted with attention to the study details. Patients in this investigation had mild to moderate PD and the enrollment criteria excluded patients whose clinicians believed needed physical/occupational therapy. Thus, one may conclude from this investigation that blanket referrals of all patients with earlier-stage PD for routine physical or occupation therapy appears to be cost-ineffective," writes J. Eric Ahlskog, Ph.D., M.D., of the Mayo Clinic, Rochester, Minn., in a related editorial.

"Intuitively, certain PD-related symptoms should benefit from routine physical therapy strategies, including problems such as gait freezing, imbalance/fall risk, or immobilized limbs. Patients with PD with shortened stride or reduced arm swing benefit from strategies for consciously increasing attenuated movements. Such circumscribed problems were not the focus of this investigation," the author notes.

"To summarize, first, current physical/occupation therapy referrals for those with PD 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," the editorial concludes.

(JAMA Neurol. Published online January 19, 2016. doi:10.1001/jamaneurol.2015.4449. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Media Advisory: To contact corresponding author Carl E. Clarke, M.D., email carlclarke@nhs.net. To contact corresponding editorial author J. Eric Ahlskog, Ph.D., M.D., call Susan Barber Lindquist at 507- 293-3228 or email barberlindquist.susan@mayo.edu.

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