Physiotherapy versus placebo or no intervention in Parkinson's disease.
Identifieur interne : 000102 ( Ncbi/Curation ); précédent : 000101; suivant : 000103Physiotherapy versus placebo or no intervention in Parkinson's disease.
Auteurs : Claire L. Tomlinson [Royaume-Uni] ; Smitaa Patel ; Charmaine Meek ; Carl E. Clarke ; Rebecca Stowe ; Laila Shah ; Catherine M. Sackley ; Katherine H O. Deane ; Clare P. Herd ; Keith Wheatley ; Natalie IvesSource :
- The Cochrane database of systematic reviews [ 1469-493X ] ; 2012.
Descripteurs français
- KwdFr :
- Arts martiaux (MeSH), Démarche (MeSH), Essais contrôlés randomisés comme sujet (MeSH), Femelle (MeSH), Humains (MeSH), Maladie de Parkinson (rééducation et réadaptation), Mâle (MeSH), Signaux (MeSH), Sujet âgé (MeSH), Techniques de physiothérapie (MeSH), Thérapie par la danse (méthodes), Traitement par les exercices physiques (méthodes).
- MESH :
- méthodes : Thérapie par la danse, Traitement par les exercices physiques.
- rééducation et réadaptation : Maladie de Parkinson.
- Arts martiaux, Démarche, Essais contrôlés randomisés comme sujet, Femelle, Humains, Mâle, Signaux, Sujet âgé, Techniques de physiothérapie.
English descriptors
- KwdEn :
- MESH :
- methods : Dance Therapy, Exercise Therapy.
- rehabilitation : Parkinson Disease.
- Aged, Cues, Female, Gait, Humans, Male, Martial Arts, Physical Therapy Modalities, Randomized Controlled Trials as Topic.
Abstract
BACKGROUND
Despite medical therapies and surgical interventions for Parkinson's disease (PD), patients develop progressive disability. The role of physiotherapy aims to maximise functional ability and minimise secondary complications through movement rehabilitation within a context of education and support for the whole person. The overall aim is to optimise independence, safety and well-being, thereby enhancing quality of life.
OBJECTIVES
To assess the effectiveness of physiotherapy intervention compared with no intervention in patients with PD.
SEARCH METHODS
We identified relevant trials by electronic searches of numerous literature databases (e.g. MEDLINE, EMBASE) and trial registers, plus handsearching of major journals, abstract books, conference proceedings and reference lists of retrieved publications. The literature search included trials published up to end of December 2010.
SELECTION CRITERIA
Randomised controlled trials of physiotherapy intervention versus no physiotherapy intervention in patients with PD.
DATA COLLECTION AND ANALYSIS
Two review authors independently extracted data from each article. We used standard meta-analysis methods to assess the effectiveness of physiotherapy intervention compared with no physiotherapy intervention. Trials were classified into the following intervention comparisons: general physiotherapy, exercise, treadmill training, cueing, dance and martial arts. We used tests for heterogeneity to assess for differences in treatment effect across these different physiotherapy interventions.
MAIN RESULTS
We identified 33 trials with 1518 participants. Compared with no-intervention, physiotherapy significantly improved the gait outcomes of velocity (mean difference 0.05 m/s, 95% confidence interval (CI): 0.02 to 0.07, P = 0.0002), two- or six-minute walk test (16.40 m, CI: 1.90 to 30.90, P = 0.03) and step length (0.03 m, CI: 0 to 0.06, P = 0.04); functional mobility and balance outcomes of Timed Up & Go test (-0.61 s, CI: -1.06 to -0.17, P = 0.006), Functional Reach Test (2.16 cm, CI: 0.89 to 3.43, P = 0.0008) and Berg Balance Scale (3.36 points, CI: 1.91 to 4.81, P < 0.00001); and clinician-rated disability using the Unified Parkinson's Disease Rating Scale (UPDRS) (total: -4.46 points, CI -7.16 to -1.75, P = 0.001; activities of daily living: -1.36, CI -2.41 to -0.30, P = 0.01; and motor: -4.09, CI: -5.59 to -2.59, P < 0.00001). There was no difference between arms in falls or patient-rated quality of life. Indirect comparisons of the different physiotherapy interventions found no evidence that the treatment effect differed across the physiotherapy interventions for any of the outcomes assessed.
AUTHORS' CONCLUSIONS
Benefit for physiotherapy was found in most outcomes over the short-term (i.e. < three months), but was only significant for velocity, two- or six-minute walk test, step length, Timed Up & Go, Functional Reach Test, Berg Balance Scale and clinician-rated UPDRS. Most of the observed differences between the treatments were small. However, for some outcomes (e.g. velocity, Berg Balance Scale and UPDRS), the differences observed were at, or approaching, what are considered minimally clinical important changes.The review illustrates that a wide range of approaches are employed by physiotherapists to treat PD. However, there was no evidence of differences in treatment effect between the different types of physiotherapy interventions being used, though this was based on indirect comparisons. There is a need to develop a consensus menu of 'best-practice' physiotherapy, and to perform large well-designed randomised controlled trials to demonstrate the longer-term efficacy and cost-effectiveness of 'best practice' physiotherapy in PD.
DOI: 10.1002/14651858.CD002817.pub2
PubMed: 22786482
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pubmed:22786482Le document en format XML
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged (MeSH)</term>
<term>Cues (MeSH)</term>
<term>Dance Therapy (methods)</term>
<term>Exercise Therapy (methods)</term>
<term>Female (MeSH)</term>
<term>Gait (MeSH)</term>
<term>Humans (MeSH)</term>
<term>Male (MeSH)</term>
<term>Martial Arts (MeSH)</term>
<term>Parkinson Disease (rehabilitation)</term>
<term>Physical Therapy Modalities (MeSH)</term>
<term>Randomized Controlled Trials as Topic (MeSH)</term>
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<keywords scheme="KwdFr" xml:lang="fr"><term>Arts martiaux (MeSH)</term>
<term>Démarche (MeSH)</term>
<term>Essais contrôlés randomisés comme sujet (MeSH)</term>
<term>Femelle (MeSH)</term>
<term>Humains (MeSH)</term>
<term>Maladie de Parkinson (rééducation et réadaptation)</term>
<term>Mâle (MeSH)</term>
<term>Signaux (MeSH)</term>
<term>Sujet âgé (MeSH)</term>
<term>Techniques de physiothérapie (MeSH)</term>
<term>Thérapie par la danse (méthodes)</term>
<term>Traitement par les exercices physiques (méthodes)</term>
</keywords>
<keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Dance Therapy</term>
<term>Exercise Therapy</term>
</keywords>
<keywords scheme="MESH" qualifier="méthodes" xml:lang="fr"><term>Thérapie par la danse</term>
<term>Traitement par les exercices physiques</term>
</keywords>
<keywords scheme="MESH" qualifier="rehabilitation" xml:lang="en"><term>Parkinson Disease</term>
</keywords>
<keywords scheme="MESH" qualifier="rééducation et réadaptation" xml:lang="fr"><term>Maladie de Parkinson</term>
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<keywords scheme="MESH" xml:lang="en"><term>Aged</term>
<term>Cues</term>
<term>Female</term>
<term>Gait</term>
<term>Humans</term>
<term>Male</term>
<term>Martial Arts</term>
<term>Physical Therapy Modalities</term>
<term>Randomized Controlled Trials as Topic</term>
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<term>Démarche</term>
<term>Essais contrôlés randomisés comme sujet</term>
<term>Femelle</term>
<term>Humains</term>
<term>Mâle</term>
<term>Signaux</term>
<term>Sujet âgé</term>
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<front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b>
</p>
<p>Despite medical therapies and surgical interventions for Parkinson's disease (PD), patients develop progressive disability. The role of physiotherapy aims to maximise functional ability and minimise secondary complications through movement rehabilitation within a context of education and support for the whole person. The overall aim is to optimise independence, safety and well-being, thereby enhancing quality of life.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>OBJECTIVES</b>
</p>
<p>To assess the effectiveness of physiotherapy intervention compared with no intervention in patients with PD.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>SEARCH METHODS</b>
</p>
<p>We identified relevant trials by electronic searches of numerous literature databases (e.g. MEDLINE, EMBASE) and trial registers, plus handsearching of major journals, abstract books, conference proceedings and reference lists of retrieved publications. The literature search included trials published up to end of December 2010.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>SELECTION CRITERIA</b>
</p>
<p>Randomised controlled trials of physiotherapy intervention versus no physiotherapy intervention in patients with PD.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>DATA COLLECTION AND ANALYSIS</b>
</p>
<p>Two review authors independently extracted data from each article. We used standard meta-analysis methods to assess the effectiveness of physiotherapy intervention compared with no physiotherapy intervention. Trials were classified into the following intervention comparisons: general physiotherapy, exercise, treadmill training, cueing, dance and martial arts. We used tests for heterogeneity to assess for differences in treatment effect across these different physiotherapy interventions.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>MAIN RESULTS</b>
</p>
<p>We identified 33 trials with 1518 participants. Compared with no-intervention, physiotherapy significantly improved the gait outcomes of velocity (mean difference 0.05 m/s, 95% confidence interval (CI): 0.02 to 0.07, P = 0.0002), two- or six-minute walk test (16.40 m, CI: 1.90 to 30.90, P = 0.03) and step length (0.03 m, CI: 0 to 0.06, P = 0.04); functional mobility and balance outcomes of Timed Up & Go test (-0.61 s, CI: -1.06 to -0.17, P = 0.006), Functional Reach Test (2.16 cm, CI: 0.89 to 3.43, P = 0.0008) and Berg Balance Scale (3.36 points, CI: 1.91 to 4.81, P < 0.00001); and clinician-rated disability using the Unified Parkinson's Disease Rating Scale (UPDRS) (total: -4.46 points, CI -7.16 to -1.75, P = 0.001; activities of daily living: -1.36, CI -2.41 to -0.30, P = 0.01; and motor: -4.09, CI: -5.59 to -2.59, P < 0.00001). There was no difference between arms in falls or patient-rated quality of life. Indirect comparisons of the different physiotherapy interventions found no evidence that the treatment effect differed across the physiotherapy interventions for any of the outcomes assessed.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>AUTHORS' CONCLUSIONS</b>
</p>
<p>Benefit for physiotherapy was found in most outcomes over the short-term (i.e. < three months), but was only significant for velocity, two- or six-minute walk test, step length, Timed Up & Go, Functional Reach Test, Berg Balance Scale and clinician-rated UPDRS. Most of the observed differences between the treatments were small. However, for some outcomes (e.g. velocity, Berg Balance Scale and UPDRS), the differences observed were at, or approaching, what are considered minimally clinical important changes.The review illustrates that a wide range of approaches are employed by physiotherapists to treat PD. However, there was no evidence of differences in treatment effect between the different types of physiotherapy interventions being used, though this was based on indirect comparisons. There is a need to develop a consensus menu of 'best-practice' physiotherapy, and to perform large well-designed randomised controlled trials to demonstrate the longer-term efficacy and cost-effectiveness of 'best practice' physiotherapy in PD.</p>
</div>
</front>
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