In spite of various medical and surgical treatments for Parkinson's disease (PD), patients gradually develop significant physical problems. Physiotherapists aim to enable people with PD to maintain their maximum level of mobility, activity and independence through monitoring their condition and targeting the appropriate treatment. A range of approaches to movement rehabilitation are used, which aim to enhance quality of life by maximising physical ability and minimising secondary complications over the whole course of the disease.
Only randomised controlled trials were included in this review. These were studies where a group of participants were given physiotherapy intervention and compared with another group who did not receive physiotherapy. The participants were assigned to a group in a random fashion to reduce the potential for bias. Thirty-three randomised trials involving 1518 participants were identified as suitable for this review. The trials assessed various physiotherapy interventions, so the trials were grouped according to the type of intervention being used (general physiotherapy, exercise, treadmill training, cueing, dance or martial arts).
There was an improvement with physiotherapy intervention in all walking outcomes (except the 10- or 20-metre walk test). However, these improvements were only significant for walking speed, walking endurance and step length. Mobility and balance outcomes were also improved with physiotherapy intervention, with significant improvements in one test of mobility (the Timed Up & Go test which times how long it takes a person to get up from a chair, walk a certain distance, then walk back to the chair and sit down) and in two tests of balance (one assessing how far a person can reach before they lose balance (Functional Reach Test) and another which assesses multiple aspects of balance (Berg Balance Scale)). Clinician-rated disability, using the Unified Parkinson’s Disease Rating Scale (UPDRS), was also improved with physiotherapy intervention. There was no difference between the two groups in data on falls or patient-rated quality of life. When comparing the different physiotherapy interventions, there was no evidence that the treatment effect differed across the physiotherapy interventions for any of the outcomes assessed.
This review provides evidence on the short-term benefit of physiotherapy for the treatment of PD. Although most of the observed differences were small, the improvements seen for walking speed, balance with the Berg Balance Scale and clinician-rated disability (using the UPDRS) were of a size that patients would consider an important improvement.