A new study suggests low-dose physical therapy and occupational therapy did not result in clinically meaningful benefits to activities of daily living or quality of life for patients with mild to moderate Parkinson’s disease.
Findings from the research, which was conducted in the United Kingdom, were published Jan. 19 on the website of JAMA Neurology. The researchers point out the need for more study on early interventions for Parkinson’s disease, while an accompanying editorial notes the results need to be interpreted carefully.
Parkinson’s disease causes problems with ADL that are only partially treated by medication and occasionally surgery. Physiotherapy and occupational therapy traditionally have been used later in the disease, according to the study.
Carl E. Clarke, MD, of the University of Birmingham, England, and co-authors 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 randomly were assigned to PT and OT (381 patients) or no therapy (381 patients). Patients were excluded from the study if their clinicians had prescribed physical or occupational therapy.
The primary outcome was ADL scores 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 noted no difference between the groups in ADL total score or on a health-related quality of life questionnaire summary index.
The authors wrote 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.”
“Future research should explore the development and testing of more structured and intensive PT programs in patients with all stages of PD,” the authors wrote.
Editorial calls for careful interpretation
In a related editorial, J. Eric Ahlskog, PhD, MD, of the Mayo Clinic in Rochester, Minn., noted the results must be interpreted carefully based on the details of the study.
“Patients in this investigation had mild to moderate PD, and the enrollment criteria excluded patients whose clinicians believed [they] needed physical/occupational therapy,” Ahlskog wrote. “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.
“Intuitively, certain PD-related symptoms should benefit from routine physical therapy strategies, including problems such as gait freezing, imbalance/fall risk, or immobilized limbs,” Ahlskog wrote. “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.”
According to the editorial, evidence from the study supports physical and occupational therapy referrals for patients with Parkinson’s disease and specific problems the intervention is likely to benefit. Ahlskog also called for physical therapy practices to incorporate support for ongoing aerobic exercise and fitness.
Similarly, in an American Physical Therapy Association PT in Motion article, researcher and physical therapy professor Theresa Ellis, PhD, PT, NCS, identified reasons why the study is not generalizable. She specifically cited a very low dose of physical therapy interventions, widely varied expertise among the PTs providing care and the makeup of the study pool.
“The very low dose of therapy – below what is typically provided in the U.S. – and the absence of an ongoing home exercise program contribute substantially to the lack of improvement observed,” Ellis said in the article.