Standard Therapy Ineffective for Parkinson Disease

Physiotherapy (PT) and occupational therapy (OT) weren’t associated with immediate or medium-term clinically meaningful improvements in activities of daily living or quality of life in mild to moderate Parkinson disease (PD), according to a new study.

In the PD REHAB Trial, researchers recruited 762 patients with mild to moderate PD from 38 sites across the United Kingdom. For the primary outcome, they used the Nottingham Extended Activities of Daily Living (NEADL), and secondary outcomes included health-related quality of life (assessed by Parkinson Disease Questionnaire–39 and EuroQol-5D), adverse events, and caregiver quality of life.
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In the open-label, parallel group, controlled efficacy trial, 381 received PT and OT and 381 had no therapy. At 3 months, the researchers saw no difference between groups in NEADL total score (difference, 0.5 points; 95% CI, −0.7 to 1.7; P = .41) or Parkinson Disease Questionnaire–39 summary index (0.007 points; 95% CI, −1.5 to 1.5; P = .99). The EuroQol-5D quotient was of “borderline significance” in favor of therapy (−0.03; 95% CI, −0.07 to −0.002; P = .04), they said. Repeated-measures analysis showed no difference in NEADL total score, but Parkinson Disease Questionnaire–39 summary index (diverging 1.6 points per annum; 95% CI, 0.47 to 2.62; P = .005) and EuroQol-5D score (0.02; 95% CI, 0.00007 to 0.03; P = .04) showed small differences in favor of therapy. They found no difference in adverse events.

“We suggest that patients with mild Parkinson disease are not referred for PT and OT at present,” said study lead author Carl E. Clarke, MD, of the School of Clinical and Experimental Medicine at the University of Birmingham.

Future research should explore the development and testing of more structured and intensive PT and OT programs in patients with all stages of PD, the investigators concluded. (In the PD REHAB Trial, the median therapist contact time was 4 visits of 58 minutes over 8 weeks.)

“We need to do much better for our patients,” stressed Clarke, noting the next step is a trial of speech and language therapy in PD (called the PD COMM trial).

-Mike Bederka

Reference:
Clarke CE, Patel S, Ives N, et al; for the PD REHAB Collaborative Group. Physiotherapy and occupational therapy vs no therapy in mild to moderate Parkinson disease: a randomized clinical trial. JAMA Neurol. Published online January 19, 2016. doi:10.1001/jamaneurol.2015.4452