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Evidence-based analysis of physical therapy in Parkinson's disease with recommendations for practice and research

Movement Disorders

March 2007
Keus SHJ, Bloem BR, Hendriks EJM, Bredero-Cohen AB, Munneke M

Physical therapy is often prescribed in Parkinson's disease. To facilitate the uniformity and efficacy of this intervention, we analyzed current evidence and developed practice recommendations. We carried out an evidence-based literature review. The results were supplemented with clinical expertise and patient values and translated into practice recommendations, developed according to international standards for guideline development. A systematic literature search yielded 6 systematic reviews and 23 randomized controlled trials of moderate methodological quality with sufficient data. Six specific core areas for physical therapy were identified: transfers, posture, reaching and grasping, balance, gait, and physical capacity. We extracted four specific treatment recommendations that were based on evidence from more than two controlled trials: cueing strategies to improve gait; cognitive movement strategies to improve transfers; exercises to improve balance; and training of joint mobility and muscle power to improve physical capacity. These practice recommendations provide a basis for current physical therapy in Parkinson's disease in everyday clinical practice, as well as for future research in this field

In the course of their disease, most patients with Parkinson's disease (PD) face mounting mobility deficits, including difficulties with transfers, posture, balance, and walking. This frequently leads to loss of independence, (fear of) falls, injuries, and inactivity, resulting in social isolation and an increased risk of osteoporosis or cardiovascular disease. Consequently, costs increase3 and quality of life decreases. These mobility deficits are difficult to treat with drugs or neurosurgery.

Physical therapy is often prescribed next to medical treatment. However, there are presently no guidelines for physical therapy in PD with practical recommendations graded according to scientific evidence. Prior research was hampered by this lack of uniform treatment recommendations. Therefore, we developed evidence-based practice recommendations according to international criteria for guideline development. With these recommendations we aim to facilitate the uniformity and efficacy of physical therapy in PD. Furthermore, practice recommendations provide referring physicians insight into the possibilities and limitations of physical therapy in PD, thereby promoting the quality of referrals. Finally, the recommendations can provide a firm basis for future research in this field.

Here, we describe the systematic analysis of evidence and the key recommendations. For detailed recommendations on referral indications and treatment options, we refer to a comprehensive description that is available online:http://www.cebp.nl or http://www.kngf.nl.