Meta-Analysis
The effects of physical therapy in Parkinson's Disease: A research synthesis,☆☆,

https://doi.org/10.1053/apmr.2001.22352Get rights and content

Abstract

de Goede CJT, Keus SHJ, Kwakkel G, Wagenaar RC. The effects of physical therapy in Parkinson's disease: a research synthesis. Arch Phys Med Rehabil 2001;82:509-15. Objective: To present a critical review and meta-analysis of studies evaluating the effects of physical therapy in patients suffering from Parkinson's disease (PD), in terms of neurologic signs, activities of daily living (ADLs), and walking ability. Data Sources: Articles published from 1966 to May 1999 were compiled by means of MEDLINE, Cochrane register of controlled trials, and CINAHL using combinations of the key words Parkinson's disease, exercise, exercise therapy, physical therapy, and group training. References presented in relevant publications were also examined. Articles written in English, German, or Dutch were included. Study Selection: Studies had to meet the following selection criteria: (1) patients with PD were included in the intervention study, (2) the effects of physical therapy (PT) were evaluated, (3) the study could be classified as true or quasi-experiment, and (4) the study was published in a journal or book. Data Extraction: Two reviewers assessed independently the methodologic quality of the data of each included study. One reviewer extracted relevant meta-analysis data. Data Synthesis: For each outcome measure the estimated effect size and the summary effect size (SES) were calculated, using fixed (ie, Hedges's g) and random effects models. The meta-analysis resulted in a significant homogeneous SES with regard to ADLs (.40; confidence interval [CI] =.17-.64) and stride length (.46; CI =.12-.82). The SES with regard to walking speed showed a significant heterogeneous SES, which remained significant after applying a random effects model (.49; CI =.21-.77). The SES with regard to neurologic signs was not significant (.22; CI = −.08 to.52). The small number of studies included and the shortcomings of the methodologic quality of these studies, however, bias the results of the present study. Conclusions: The results of the present research synthesis support the hypothesis that Parkinson patients benefit from PT added to their standard medication. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Section snippets

Literature search

The database of articles published from 1966 to May 1999 was compiled by means of MEDLINE, CINAHL, and Cochrane register of controlled trials using combinations of the key words Parkinson's disease, exercise, exercise therapy, physical therapy, and group training. References presented in relevant publications were also examined. Only articles written in English, German, or Dutch were included.

Studies had to meet the following selection criteria: (1) patients with PD were included in the study,

Results

A total of 19 studies were initially found. Seven studies were classified as pre-experiments.11, 24, 25, 26, 27, 28, 29 These studies were excluded from further analysis because of a lack of experimental control. The remaining 12 studies were included in the meta-analysis. Group, patient, and treatment characteristics are shown in table 1.

. Study Characteristics of 12 Experiments on the Effect of PT on PD

Reference (total n)E/C (n)Ind or Group (E/C)Mean Age (E/C) (yr)Duration of PD (E/C) (yr)Type

Discussion

On the basis of previous reviews, it was hypothesized that PT is an important adjunct to pharmacologic treatment in patients with PD, with regard to neurologic symptoms (eg, tremor, bradykinesia, rigidity), walking ability, ADLs, and QOL.

The results of our research synthesis support the hypothesis that patients with PD benefit from PT in terms of ADLs and walking ability (walking speed, stride length), but not in terms of neurologic signs. In only 18 of 12 studies the effect of PT on the QOL

Conclusion

Important limitations of the present research synthesis are the small amount of controlled intervention studies included, the poor methodologic quality of most of the intervention studies, selection-bias by unpublished papers, and studies published in foreign languages. However, the increasing number of well-controlled intervention studies published in the last 5 years holds an important promise for the future with regard to evidence-based PT.

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    Supported by the Parkinson Patiënten Vereniging and Prinses Beatrix Fonds (grant no. P00-03-11).

    ☆☆

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or any organization with which the author(s) is/are associated.

    Reprint requests to Cees J.T. de Goede, PT, Dept of Physical Therapy, University Hospital Vrije Universiteit, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam, The Netherlands, e-mail: [email protected].

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