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Meta-Analysis Finds No Difference in Outcomes With Standard vs Nonstandard PT for PD
A systematic review and meta-analysis of physical therapy (PT) in patients with Parkinson disease (PD) found no significant difference between standard PT and nonstandard PT for balance, gait, and motor outcomes. Researchers published their findings online in JAMA Network Open.
“These findings should be interpreted with caution and confirmed with better-powered studies,” wrote corresponding author Ramzi G. Salloum, PhD, of the University of Florida College of Medicine Department of Health Outcomes and Biomedical Informatics, Gainesville, Florida, and study coauthors. “More controlled trials and comparative effectiveness studies are needed to evaluate the risks, benefits, and durability of each type of PT intervention and to guide better implementation.”
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The systematic review and meta-analysis investigated the current evidence on PT for people with PD, including type, timing, frequency, and outcome durability. Some 46 randomized clinical trials spanning 3905 patients with PD were included. Among the trials, 10 compared 2 types of nonstandard PT interventions; 26 compared nonstandard and standard PT; and 10 compared PT with no intervention. Aquatic PT was the most common nonconventional PT studied.
In most trials, PT regimens ranged from 2 to 12 weeks, occurring 2 to 3 times a week. Sessions tended to last between 30 to 60 minutes, researchers reported.
Just 30% of trials reported on gait outcomes, 22% on balance outcomes, 9% on quality of life outcomes, and 2% on cognition outcomes. Nearly half of all trials reported durability of benefit after the PT regimen was completed.
Meta-analysis results lacked statistical significance for PT compared with no intervention in Unified Parkinson’s Disease Rating Scale (UPDRS) score; researchers reported a standardized men difference (SMD) of −1.09. Additionally, meta-analysis indicated no significant difference between nonstandard and standard PT for balance (0.54 SMD), gait (0.03 SMD), and UPDRS (−0.49 SMD). Differences in outcomes by PT frequency per week were also not significant.
“Although PT for PD has been shown to be associated with mobility benefits and there are guidelines for implementation, research is needed to better define the ideal type, timing, frequency, and duration,” the authors advised.
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