Physiotherapy intervention in Parkinson’s disease: systematic review and meta-analysis
Identifieur interne : 001719 ( Main/Corpus ); précédent : 001718; suivant : 001720Physiotherapy intervention in Parkinson’s disease: systematic review and meta-analysis
Auteurs : Claire L. Tomlinson ; Smitaa Patel ; Charmaine Meek ; Clare P. Herd ; Carl E. Clarke ; Rebecca Stowe ; Laila Shah ; Catherine Sackley ; Katherine H O. Deane ; Keith Wheatley ; Natalie IvesSource :
- BMJ : British Medical Journal [ 1756-1833 ] ; 2012.
Abstract
Objective To assess the effectiveness of physiotherapy compared with no intervention in patients with Parkinson’s disease. Design Systematic review and meta-analysis of randomised controlled trials. Data sources Literature databases, trial registries, journals, abstract books, and conference proceedings, and reference lists, searched up to the end of January 2012. Review methods Randomised controlled trials comparing physiotherapy with no intervention in patients with Parkinson’s disease were eligible. Two authors independently abstracted data from each trial. Standard meta-analysis methods were used to assess the effectiveness of physiotherapy compared with no intervention. Tests for heterogeneity were used to assess for differences in treatment effect across different physiotherapy interventions used. Outcome measures were gait, functional mobility and balance, falls, clinician rated impairment and disability measures, patient rated quality of life, adverse events, compliance, and economic analysis outcomes. Results 39 trials of 1827 participants met the inclusion criteria, of which 29 trials provided data for the meta-analyses. Significant benefit from physiotherapy was reported for nine of 18 outcomes assessed. Outcomes which may be clinically significant were speed (0.04 m/s, 95% confidence interval 0.02 to 0.06, P<0.001), Berg balance scale (3.71 points, 2.30 to 5.11, P<0.001), and scores on the unified Parkinson’s disease rating scale (total score −6.15 points, −8.57 to −3.73, P<0.001; activities of daily living subscore −1.36, −2.41 to −0.30, P=0.01; motor subscore −5.01, −6.30 to −3.72, P<0.001). Indirect comparisons of the different physiotherapy interventions found no evidence that the treatment effect differed across the interventions for any outcomes assessed, apart from motor subscores on the unified Parkinson’s disease rating scale (in which one trial was found to be the cause of the heterogeneity). Conclusions Physiotherapy has short term benefits in Parkinson’s disease. A wide range of physiotherapy techniques are currently used to treat Parkinson’s disease, with little difference in treatment effects. Large, well designed, randomised controlled trials with improved methodology and reporting are needed to assess the efficacy and cost effectiveness of physiotherapy for treating Parkinson’s disease in the longer term.
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DOI: 10.1136/bmj.e5004
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Tomlinson</name><affiliation><mods:affiliation>Birmingham Clinical Trials Unit, University of Birmingham, Birmingham B15 2TT, UK</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: c.l.smith.1@bham.ac.uk</mods:affiliation></affiliation></author><author><name sortKey="Patel, Smitaa" sort="Patel, Smitaa" uniqKey="Patel S" first="Smitaa" last="Patel">Smitaa Patel</name><affiliation><mods:affiliation>Birmingham Clinical Trials Unit, University of Birmingham, Birmingham B15 2TT, UK</mods:affiliation></affiliation></author><author><name sortKey="Meek, Charmaine" sort="Meek, Charmaine" uniqKey="Meek C" first="Charmaine" last="Meek">Charmaine Meek</name><affiliation><mods:affiliation>Birmingham Clinical Trials Unit, University of Birmingham, Birmingham B15 2TT, UK</mods:affiliation></affiliation></author><author><name sortKey="Herd, Clare P" sort="Herd, Clare P" uniqKey="Herd C" first="Clare P" last="Herd">Clare P. Herd</name><affiliation><mods:affiliation>School of Clinical and Experimental Medicine, College of Medicine and Dental Sciences, University of Birmingham</mods:affiliation></affiliation></author><author><name sortKey="Clarke, Carl E" sort="Clarke, Carl E" uniqKey="Clarke C" first="Carl E" last="Clarke">Carl E. Clarke</name><affiliation><mods:affiliation>School of Clinical and Experimental Medicine, College of Medicine and Dental Sciences, University of Birmingham</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology, Sandwell and West Birmingham Hospitals NHS Trust, City Hospital, Birmingham</mods:affiliation></affiliation></author><author><name sortKey="Stowe, Rebecca" sort="Stowe, Rebecca" uniqKey="Stowe R" first="Rebecca" last="Stowe">Rebecca Stowe</name><affiliation><mods:affiliation>Birmingham Clinical Trials Unit, University of Birmingham, Birmingham B15 2TT, UK</mods:affiliation></affiliation></author><author><name sortKey="Shah, Laila" sort="Shah, Laila" uniqKey="Shah L" first="Laila" last="Shah">Laila Shah</name><affiliation><mods:affiliation>Birmingham Clinical Trials Unit, University of Birmingham, Birmingham B15 2TT, UK</mods:affiliation></affiliation></author><author><name sortKey="Sackley, Catherine" sort="Sackley, Catherine" uniqKey="Sackley C" first="Catherine" last="Sackley">Catherine Sackley</name><affiliation><mods:affiliation>University of East Anglia, Norwich, UK</mods:affiliation></affiliation></author><author><name sortKey="Deane, Katherine H O" sort="Deane, Katherine H O" uniqKey="Deane K" first="Katherine H O" last="Deane">Katherine H O. 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Tomlinson</name><affiliation><mods:affiliation>Birmingham Clinical Trials Unit, University of Birmingham, Birmingham B15 2TT, UK</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: c.l.smith.1@bham.ac.uk</mods:affiliation></affiliation></author><author><name sortKey="Patel, Smitaa" sort="Patel, Smitaa" uniqKey="Patel S" first="Smitaa" last="Patel">Smitaa Patel</name><affiliation><mods:affiliation>Birmingham Clinical Trials Unit, University of Birmingham, Birmingham B15 2TT, UK</mods:affiliation></affiliation></author><author><name sortKey="Meek, Charmaine" sort="Meek, Charmaine" uniqKey="Meek C" first="Charmaine" last="Meek">Charmaine Meek</name><affiliation><mods:affiliation>Birmingham Clinical Trials Unit, University of Birmingham, Birmingham B15 2TT, UK</mods:affiliation></affiliation></author><author><name sortKey="Herd, Clare P" sort="Herd, Clare P" uniqKey="Herd C" first="Clare P" last="Herd">Clare P. Herd</name><affiliation><mods:affiliation>School of Clinical and Experimental Medicine, College of Medicine and Dental Sciences, University of Birmingham</mods:affiliation></affiliation></author><author><name sortKey="Clarke, Carl E" sort="Clarke, Carl E" uniqKey="Clarke C" first="Carl E" last="Clarke">Carl E. Clarke</name><affiliation><mods:affiliation>School of Clinical and Experimental Medicine, College of Medicine and Dental Sciences, University of Birmingham</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology, Sandwell and West Birmingham Hospitals NHS Trust, City Hospital, Birmingham</mods:affiliation></affiliation></author><author><name sortKey="Stowe, Rebecca" sort="Stowe, Rebecca" uniqKey="Stowe R" first="Rebecca" last="Stowe">Rebecca Stowe</name><affiliation><mods:affiliation>Birmingham Clinical Trials Unit, University of Birmingham, Birmingham B15 2TT, UK</mods:affiliation></affiliation></author><author><name sortKey="Shah, Laila" sort="Shah, Laila" uniqKey="Shah L" first="Laila" last="Shah">Laila Shah</name><affiliation><mods:affiliation>Birmingham Clinical Trials Unit, University of Birmingham, Birmingham B15 2TT, UK</mods:affiliation></affiliation></author><author><name sortKey="Sackley, Catherine" sort="Sackley, Catherine" uniqKey="Sackley C" first="Catherine" last="Sackley">Catherine Sackley</name><affiliation><mods:affiliation>University of East Anglia, Norwich, UK</mods:affiliation></affiliation></author><author><name sortKey="Deane, Katherine H O" sort="Deane, Katherine H O" uniqKey="Deane K" first="Katherine H O" last="Deane">Katherine H O. Deane</name><affiliation><mods:affiliation>University of East Anglia, Norwich, UK</mods:affiliation></affiliation></author><author><name sortKey="Wheatley, Keith" sort="Wheatley, Keith" uniqKey="Wheatley K" first="Keith" last="Wheatley">Keith Wheatley</name><affiliation><mods:affiliation>Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, University of Birmingham</mods:affiliation></affiliation></author><author><name sortKey="Ives, Natalie" sort="Ives, Natalie" uniqKey="Ives N" first="Natalie" last="Ives">Natalie Ives</name><affiliation><mods:affiliation>Birmingham Clinical Trials Unit, University of Birmingham, Birmingham B15 2TT, UK</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">BMJ : British Medical Journal</title><title level="j" type="abbrev">BMJ</title><idno type="eISSN">1756-1833</idno><imprint><publisher>British Medical Journal Publishing Group</publisher><date>2012</date><biblScope unit="volume">345</biblScope></imprint></series><idno type="istex">76F28FD69674A9085206DEA896CE201F5FDB97DD</idno><idno type="DOI">10.1136/bmj.e5004</idno><idno type="href">bmj-345-bmj-e5004.pdf</idno><idno type="ArticleID">tomc002253</idno><idno type="local">bmj;345/aug06_1/e5004</idno></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Objective To assess the effectiveness of physiotherapy compared with no intervention in patients with Parkinson’s disease. Design Systematic review and meta-analysis of randomised controlled trials. Data sources Literature databases, trial registries, journals, abstract books, and conference proceedings, and reference lists, searched up to the end of January 2012. Review methods Randomised controlled trials comparing physiotherapy with no intervention in patients with Parkinson’s disease were eligible. Two authors independently abstracted data from each trial. Standard meta-analysis methods were used to assess the effectiveness of physiotherapy compared with no intervention. Tests for heterogeneity were used to assess for differences in treatment effect across different physiotherapy interventions used. Outcome measures were gait, functional mobility and balance, falls, clinician rated impairment and disability measures, patient rated quality of life, adverse events, compliance, and economic analysis outcomes. Results 39 trials of 1827 participants met the inclusion criteria, of which 29 trials provided data for the meta-analyses. Significant benefit from physiotherapy was reported for nine of 18 outcomes assessed. Outcomes which may be clinically significant were speed (0.04 m/s, 95% confidence interval 0.02 to 0.06, P<0.001), Berg balance scale (3.71 points, 2.30 to 5.11, P<0.001), and scores on the unified Parkinson’s disease rating scale (total score −6.15 points, −8.57 to −3.73, P<0.001; activities of daily living subscore −1.36, −2.41 to −0.30, P=0.01; motor subscore −5.01, −6.30 to −3.72, P<0.001). Indirect comparisons of the different physiotherapy interventions found no evidence that the treatment effect differed across the interventions for any outcomes assessed, apart from motor subscores on the unified Parkinson’s disease rating scale (in which one trial was found to be the cause of the heterogeneity). Conclusions Physiotherapy has short term benefits in Parkinson’s disease. A wide range of physiotherapy techniques are currently used to treat Parkinson’s disease, with little difference in treatment effects. Large, well designed, randomised controlled trials with improved methodology and reporting are needed to assess the efficacy and cost effectiveness of physiotherapy for treating Parkinson’s disease in the longer term.</div></front></TEI><istex><corpusName>bmj</corpusName><author><json:item><name>Claire L Tomlinson</name><affiliations><json:string>Birmingham Clinical Trials Unit, University of Birmingham, Birmingham B15 2TT, UK</json:string><json:string>E-mail: c.l.smith.1@bham.ac.uk</json:string></affiliations></json:item><json:item><name>Smitaa Patel</name><affiliations><json:string>Birmingham Clinical Trials Unit, University of Birmingham, Birmingham B15 2TT, UK</json:string></affiliations></json:item><json:item><name>Charmaine Meek</name><affiliations><json:string>Birmingham Clinical Trials Unit, University of Birmingham, Birmingham B15 2TT, UK</json:string></affiliations></json:item><json:item><name>Clare P Herd</name><affiliations><json:string>School of Clinical and Experimental Medicine, College of Medicine and Dental Sciences, University of Birmingham</json:string></affiliations></json:item><json:item><name>Carl E Clarke</name><affiliations><json:string>School of Clinical and Experimental Medicine, College of Medicine and Dental Sciences, University of Birmingham</json:string><json:string>Department of Neurology, Sandwell and West Birmingham Hospitals NHS Trust, City Hospital, Birmingham</json:string></affiliations></json:item><json:item><name>Rebecca Stowe</name><affiliations><json:string>Birmingham Clinical Trials Unit, University of Birmingham, Birmingham B15 2TT, UK</json:string></affiliations></json:item><json:item><name>Laila Shah</name><affiliations><json:string>Birmingham Clinical Trials Unit, University of Birmingham, Birmingham B15 2TT, UK</json:string></affiliations></json:item><json:item><name>Catherine Sackley</name><affiliations><json:string>University of East Anglia, Norwich, UK</json:string></affiliations></json:item><json:item><name>Katherine H O Deane</name><affiliations><json:string>University of East Anglia, Norwich, UK</json:string></affiliations></json:item><json:item><name>Keith Wheatley</name><affiliations><json:string>Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, University of Birmingham</json:string></affiliations></json:item><json:item><name>Natalie Ives</name><affiliations><json:string>Birmingham Clinical Trials Unit, University of Birmingham, Birmingham B15 2TT, UK</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Research</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>UK</value></json:item></subject><language><json:string>eng</json:string></language><abstract>Objective To assess the effectiveness of physiotherapy compared with no intervention in patients with Parkinson’s disease. Design Systematic review and meta-analysis of randomised controlled trials. Data sources Literature databases, trial registries, journals, abstract books, and conference proceedings, and reference lists, searched up to the end of January 2012. Review methods Randomised controlled trials comparing physiotherapy with no intervention in patients with Parkinson’s disease were eligible. Two authors independently abstracted data from each trial. Standard meta-analysis methods were used to assess the effectiveness of physiotherapy compared with no intervention. Tests for heterogeneity were used to assess for differences in treatment effect across different physiotherapy interventions used. Outcome measures were gait, functional mobility and balance, falls, clinician rated impairment and disability measures, patient rated quality of life, adverse events, compliance, and economic analysis outcomes. Results 39 trials of 1827 participants met the inclusion criteria, of which 29 trials provided data for the meta-analyses. Significant benefit from physiotherapy was reported for nine of 18 outcomes assessed. Outcomes which may be clinically significant were speed (0.04 m/s, 95% confidence interval 0.02 to 0.06, P>0.001), Berg balance scale (3.71 points, 2.30 to 5.11, P>0.001), and scores on the unified Parkinson’s disease rating scale (total score −6.15 points, −8.57 to −3.73, P>0.001; activities of daily living subscore −1.36, −2.41 to −0.30, P=0.01; motor subscore −5.01, −6.30 to −3.72, P>0.001). Indirect comparisons of the different physiotherapy interventions found no evidence that the treatment effect differed across the interventions for any outcomes assessed, apart from motor subscores on the unified Parkinson’s disease rating scale (in which one trial was found to be the cause of the heterogeneity). Conclusions Physiotherapy has short term benefits in Parkinson’s disease. A wide range of physiotherapy techniques are currently used to treat Parkinson’s disease, with little difference in treatment effects. Large, well designed, randomised controlled trials with improved methodology and reporting are needed to assess the efficacy and cost effectiveness of physiotherapy for treating Parkinson’s disease in the longer term.</abstract><qualityIndicators><score>8.5</score><pdfVersion>1.4</pdfVersion><pdfPageSize>595.276 x 841.89 pts (A4)</pdfPageSize><refBibsNative>false</refBibsNative><keywordCount>2</keywordCount><abstractCharCount>2374</abstractCharCount><pdfWordCount>7298</pdfWordCount><pdfCharCount>50490</pdfCharCount><pdfPageCount>14</pdfPageCount><abstractWordCount>327</abstractWordCount></qualityIndicators><title>Physiotherapy intervention in Parkinson’s disease: systematic review and meta-analysis</title><genre><json:string>research-article</json:string></genre><host><volume>345</volume><genre></genre><language><json:string>unknown</json:string></language><eissn><json:string>1756-1833</json:string></eissn><title>BMJ : British Medical 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(INIST-CNRS)"></respStmt></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>British Medical Journal Publishing Group</publisher><availability><p>BMJ</p></availability><date>2012</date></publicationStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">Physiotherapy intervention in Parkinson’s disease: systematic review and meta-analysis</title><author corresp="yes"><persName><forename type="first">Claire L</forename><surname>Tomlinson</surname></persName><email>c.l.smith.1@bham.ac.uk</email><note type="biography">systematic reviewer</note><affiliation>systematic reviewer</affiliation><affiliation>Birmingham Clinical Trials Unit, University of Birmingham, Birmingham B15 2TT, UK</affiliation></author><author><persName><forename type="first">Smitaa</forename><surname>Patel</surname></persName><note type="biography">statistician</note><affiliation>statistician</affiliation><affiliation>Birmingham Clinical Trials Unit, University of Birmingham, Birmingham B15 2TT, UK</affiliation></author><author><persName><forename type="first">Charmaine</forename><surname>Meek</surname></persName><note type="biography">research assistant</note><affiliation>research assistant</affiliation><affiliation>Birmingham Clinical Trials Unit, University of Birmingham, Birmingham B15 2TT, UK</affiliation></author><author><persName><forename type="first">Clare P</forename><surname>Herd</surname></persName><note type="biography">research associate</note><affiliation>research associate</affiliation><affiliation>School of Clinical and Experimental Medicine, College of Medicine and Dental Sciences, University of Birmingham</affiliation></author><author><persName><forename type="first">Carl E</forename><surname>Clarke</surname></persName><note type="biography">professor</note><affiliation>professor</affiliation><affiliation>School of Clinical and Experimental Medicine, College of Medicine and Dental Sciences, University of Birmingham</affiliation><affiliation>Department of Neurology, Sandwell and West Birmingham Hospitals NHS Trust, City Hospital, Birmingham</affiliation></author><author><persName><forename type="first">Rebecca</forename><surname>Stowe</surname></persName><note type="biography">senior systematic reviewer</note><affiliation>senior systematic reviewer</affiliation><affiliation>Birmingham Clinical Trials Unit, University of Birmingham, Birmingham B15 2TT, UK</affiliation></author><author><persName><forename type="first">Laila</forename><surname>Shah</surname></persName><note type="biography">research administrator</note><affiliation>research administrator</affiliation><affiliation>Birmingham Clinical Trials Unit, University of Birmingham, Birmingham B15 2TT, UK</affiliation></author><author><persName><forename type="first">Catherine</forename><surname>Sackley</surname></persName><note type="biography">professor of physiotherapy research</note><affiliation>professor of physiotherapy research</affiliation><affiliation>University of East Anglia, Norwich, UK</affiliation></author><author><persName><forename type="first">Katherine H O</forename><surname>Deane</surname></persName><note type="biography">senior lecturer in research</note><affiliation>senior lecturer in research</affiliation><affiliation>University of East Anglia, Norwich, UK</affiliation></author><author><persName><forename type="first">Keith</forename><surname>Wheatley</surname></persName><note type="biography">professor</note><affiliation>professor</affiliation><affiliation>Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, University of Birmingham</affiliation></author><author><persName><forename type="first">Natalie</forename><surname>Ives</surname></persName><note type="biography">senior statistician</note><affiliation>senior statistician</affiliation><affiliation>Birmingham Clinical Trials Unit, University of Birmingham, Birmingham B15 2TT, UK</affiliation></author></analytic><monogr><title level="j">BMJ : British Medical Journal</title><title level="j" type="abbrev">BMJ</title><idno type="eISSN">1756-1833</idno><imprint><publisher>British Medical Journal Publishing Group</publisher><date>2012</date><biblScope unit="volume">345</biblScope></imprint></monogr><idno type="istex">76F28FD69674A9085206DEA896CE201F5FDB97DD</idno><idno type="DOI">10.1136/bmj.e5004</idno><idno type="href">bmj-345-bmj-e5004.pdf</idno><idno type="ArticleID">tomc002253</idno><idno type="local">bmj;345/aug06_1/e5004</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2012</date></creation><langUsage><language ident="en">en</language></langUsage><abstract><p>Objective To assess the effectiveness of physiotherapy compared with no intervention in patients with Parkinson’s disease. Design Systematic review and meta-analysis of randomised controlled trials. Data sources Literature databases, trial registries, journals, abstract books, and conference proceedings, and reference lists, searched up to the end of January 2012. Review methods Randomised controlled trials comparing physiotherapy with no intervention in patients with Parkinson’s disease were eligible. Two authors independently abstracted data from each trial. Standard meta-analysis methods were used to assess the effectiveness of physiotherapy compared with no intervention. Tests for heterogeneity were used to assess for differences in treatment effect across different physiotherapy interventions used. Outcome measures were gait, functional mobility and balance, falls, clinician rated impairment and disability measures, patient rated quality of life, adverse events, compliance, and economic analysis outcomes. Results 39 trials of 1827 participants met the inclusion criteria, of which 29 trials provided data for the meta-analyses. Significant benefit from physiotherapy was reported for nine of 18 outcomes assessed. Outcomes which may be clinically significant were speed (0.04 m/s, 95% confidence interval 0.02 to 0.06, P<0.001), Berg balance scale (3.71 points, 2.30 to 5.11, P<0.001), and scores on the unified Parkinson’s disease rating scale (total score −6.15 points, −8.57 to −3.73, P<0.001; activities of daily living subscore −1.36, −2.41 to −0.30, P=0.01; motor subscore −5.01, −6.30 to −3.72, P<0.001). Indirect comparisons of the different physiotherapy interventions found no evidence that the treatment effect differed across the interventions for any outcomes assessed, apart from motor subscores on the unified Parkinson’s disease rating scale (in which one trial was found to be the cause of the heterogeneity). Conclusions Physiotherapy has short term benefits in Parkinson’s disease. A wide range of physiotherapy techniques are currently used to treat Parkinson’s disease, with little difference in treatment effects. Large, well designed, randomised controlled trials with improved methodology and reporting are needed to assess the efficacy and cost effectiveness of physiotherapy for treating Parkinson’s disease in the longer term.</p></abstract><textClass><keywords scheme="keyword"><list><head>hwp-journal-coll</head><item><term>UK</term></item></list></keywords></textClass></profileDesc><revisionDesc><change>undefined</change><change>[object Object]</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/76F28FD69674A9085206DEA896CE201F5FDB97DD/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus bmj" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="no"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Archiving and Interchange DTD v2.3 20070202//EN" URI="archivearticle.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article"><front><journal-meta><journal-id journal-id-type="hwp">bmj</journal-id><journal-id journal-id-type="nlm-ta">BMJ</journal-id><journal-id journal-id-type="publisher-id">bmj</journal-id><journal-title>BMJ : British Medical Journal</journal-title><issn pub-type="epub">1756-1833</issn><publisher><publisher-name>British Medical Journal Publishing Group</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">tomc002253</article-id><article-id pub-id-type="doi">10.1136/bmj.e5004</article-id><article-id pub-id-type="other">bmj;345/aug06_1/e5004</article-id><article-id pub-id-type="other">bmj;bmj.e5004</article-id><article-id pub-id-type="other">aug06_1</article-id><article-id pub-id-type="other">bmj.e5004</article-id><article-id pub-id-type="other">bmj.e5004</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>UK</subject></subj-group></article-categories><title-group><article-title>Physiotherapy intervention in Parkinson’s disease: systematic review and meta-analysis </article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Tomlinson</surname><given-names>Claire L</given-names></name><role>systematic reviewer</role><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Patel</surname><given-names>Smitaa</given-names></name><role>statistician</role><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Meek</surname><given-names>Charmaine</given-names></name><role>research assistant</role><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Herd</surname><given-names>Clare P</given-names></name><role>research associate</role><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Clarke</surname><given-names>Carl E</given-names></name><role>professor</role><xref ref-type="aff" rid="aff2">2</xref><xref ref-type="aff" rid="aff3">3</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Stowe</surname><given-names>Rebecca</given-names></name><role>senior systematic reviewer</role><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Shah</surname><given-names>Laila</given-names></name><role>research administrator</role><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Sackley</surname><given-names>Catherine</given-names></name><role>professor of physiotherapy research</role><xref ref-type="aff" rid="aff4">4</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Deane</surname><given-names>Katherine H O</given-names></name><role>senior lecturer in research</role><xref ref-type="aff" rid="aff4">4</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Wheatley</surname><given-names>Keith</given-names></name><role>professor</role><xref ref-type="aff" rid="aff5">5</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Ives</surname><given-names>Natalie</given-names></name><role>senior statistician</role><xref ref-type="aff" rid="aff1">1</xref></contrib><aff id="aff1"><label>1</label>Birmingham Clinical Trials Unit, University of Birmingham, Birmingham B15 2TT, UK</aff><aff id="aff2"><label>2</label>School of Clinical and Experimental Medicine, College of Medicine and Dental Sciences, University of Birmingham</aff><aff id="aff3"><label>3</label>Department of Neurology, Sandwell and West Birmingham Hospitals NHS Trust, City Hospital, Birmingham</aff><aff id="aff4"><label>4</label>University of East Anglia, Norwich, UK</aff><aff id="aff5"><label>5</label>Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, University of Birmingham</aff></contrib-group><author-notes><corresp>Correspondence to: C Tomlinson <email>c.l.smith.1@bham.ac.uk</email></corresp></author-notes><pub-date pub-type="collection"><year>2012</year></pub-date><pub-date pub-type="epub-original"><year>2012</year></pub-date><volume>345</volume><volume-id pub-id-type="other">345</volume-id><volume-id pub-id-type="other">345</volume-id><elocation-id>e5004</elocation-id><history><date date-type="accepted"><day>04</day><month>July</month><year>2012</year></date></history><permissions><copyright-statement>© Tomlinson et al 2012</copyright-statement><copyright-year>2012</copyright-year><copyright-holder>Tomlinson et al</copyright-holder><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/"><p>This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: <ext-link xlink:href="http://creativecommons.org/licenses/by-nc/2.0/" ext-link-type="uri">http://creativecommons.org/licenses/by-nc/2.0/</ext-link> and <ext-link xlink:href="http://creativecommons.org/licenses/by-nc/2.0/legalcode" ext-link-type="uri">http://creativecommons.org/licenses/by-nc/2.0/legalcode</ext-link>.</p></license></permissions><self-uri content-type="pdf" xlink:role="full-text" xlink:href="bmj-345-bmj-e5004.pdf"></self-uri><abstract><p><bold>Objective</bold> To assess the effectiveness of physiotherapy compared with no intervention in patients with Parkinson’s disease.</p><p><bold>Design</bold> Systematic review and meta-analysis of randomised controlled trials.</p><p><bold>Data sources</bold> Literature databases, trial registries, journals, abstract books, and conference proceedings, and reference lists, searched up to the end of January 2012.</p><p><bold>Review methods</bold> Randomised controlled trials comparing physiotherapy with no intervention in patients with Parkinson’s disease were eligible. Two authors independently abstracted data from each trial. Standard meta-analysis methods were used to assess the effectiveness of physiotherapy compared with no intervention. Tests for heterogeneity were used to assess for differences in treatment effect across different physiotherapy interventions used. Outcome measures were gait, functional mobility and balance, falls, clinician rated impairment and disability measures, patient rated quality of life, adverse events, compliance, and economic analysis outcomes.</p><p><bold>Results</bold> 39 trials of 1827 participants met the inclusion criteria, of which 29 trials provided data for the meta-analyses. Significant benefit from physiotherapy was reported for nine of 18 outcomes assessed. Outcomes which may be clinically significant were speed (0.04 m/s, 95% confidence interval 0.02 to 0.06, P<0.001), Berg balance scale (3.71 points, 2.30 to 5.11, P<0.001), and scores on the unified Parkinson’s disease rating scale (total score −6.15 points, −8.57 to −3.73, P<0.001; activities of daily living subscore −1.36, −2.41 to −0.30, P=0.01; motor subscore −5.01, −6.30 to −3.72, P<0.001). Indirect comparisons of the different physiotherapy interventions found no evidence that the treatment effect differed across the interventions for any outcomes assessed, apart from motor subscores on the unified Parkinson’s disease rating scale (in which one trial was found to be the cause of the heterogeneity).</p><p><bold>Conclusions</bold> Physiotherapy has short term benefits in Parkinson’s disease. A wide range of physiotherapy techniques are currently used to treat Parkinson’s disease, with little difference in treatment effects. Large, well designed, randomised controlled trials with improved methodology and reporting are needed to assess the efficacy and cost effectiveness of physiotherapy for treating Parkinson’s disease in the longer term.</p></abstract></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>Physiotherapy intervention in Parkinson’s disease: systematic review and meta-analysis</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Physiotherapy intervention in Parkinson’s disease: systematic review and meta-analysis</title></titleInfo><name type="personal" displayLabel="corresp"><namePart type="given">Claire L</namePart><namePart type="family">Tomlinson</namePart><affiliation>Birmingham Clinical Trials Unit, University of Birmingham, Birmingham B15 2TT, UK</affiliation><affiliation>E-mail: c.l.smith.1@bham.ac.uk</affiliation><description>systematic reviewer</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Smitaa</namePart><namePart type="family">Patel</namePart><affiliation>Birmingham Clinical Trials Unit, University of Birmingham, Birmingham B15 2TT, UK</affiliation><description>statistician</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Charmaine</namePart><namePart type="family">Meek</namePart><affiliation>Birmingham Clinical Trials Unit, University of Birmingham, Birmingham B15 2TT, UK</affiliation><description>research assistant</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Clare P</namePart><namePart type="family">Herd</namePart><affiliation>School of Clinical and Experimental Medicine, College of Medicine and Dental Sciences, University of Birmingham</affiliation><description>research associate</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Carl E</namePart><namePart type="family">Clarke</namePart><affiliation>School of Clinical and Experimental Medicine, College of Medicine and Dental Sciences, University of Birmingham</affiliation><affiliation>Department of Neurology, Sandwell and West Birmingham Hospitals NHS Trust, City Hospital, Birmingham</affiliation><description>professor</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Rebecca</namePart><namePart type="family">Stowe</namePart><affiliation>Birmingham Clinical Trials Unit, University of Birmingham, Birmingham B15 2TT, UK</affiliation><description>senior systematic reviewer</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Laila</namePart><namePart type="family">Shah</namePart><affiliation>Birmingham Clinical Trials Unit, University of Birmingham, Birmingham B15 2TT, UK</affiliation><description>research administrator</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Catherine</namePart><namePart type="family">Sackley</namePart><affiliation>University of East Anglia, Norwich, UK</affiliation><description>professor of physiotherapy research</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Katherine H O</namePart><namePart type="family">Deane</namePart><affiliation>University of East Anglia, Norwich, UK</affiliation><description>senior lecturer in research</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Keith</namePart><namePart type="family">Wheatley</namePart><affiliation>Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, University of Birmingham</affiliation><description>professor</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Natalie</namePart><namePart type="family">Ives</namePart><affiliation>Birmingham Clinical Trials Unit, University of Birmingham, Birmingham B15 2TT, UK</affiliation><description>senior statistician</description><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article"></genre><subject><genre>hwp-journal-coll</genre><topic>UK</topic></subject><originInfo><publisher>British Medical Journal Publishing Group</publisher><copyrightDate encoding="w3cdtf">2012</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract>Objective To assess the effectiveness of physiotherapy compared with no intervention in patients with Parkinson’s disease. Design Systematic review and meta-analysis of randomised controlled trials. Data sources Literature databases, trial registries, journals, abstract books, and conference proceedings, and reference lists, searched up to the end of January 2012. Review methods Randomised controlled trials comparing physiotherapy with no intervention in patients with Parkinson’s disease were eligible. Two authors independently abstracted data from each trial. Standard meta-analysis methods were used to assess the effectiveness of physiotherapy compared with no intervention. Tests for heterogeneity were used to assess for differences in treatment effect across different physiotherapy interventions used. Outcome measures were gait, functional mobility and balance, falls, clinician rated impairment and disability measures, patient rated quality of life, adverse events, compliance, and economic analysis outcomes. Results 39 trials of 1827 participants met the inclusion criteria, of which 29 trials provided data for the meta-analyses. Significant benefit from physiotherapy was reported for nine of 18 outcomes assessed. Outcomes which may be clinically significant were speed (0.04 m/s, 95% confidence interval 0.02 to 0.06, P<0.001), Berg balance scale (3.71 points, 2.30 to 5.11, P<0.001), and scores on the unified Parkinson’s disease rating scale (total score −6.15 points, −8.57 to −3.73, P<0.001; activities of daily living subscore −1.36, −2.41 to −0.30, P=0.01; motor subscore −5.01, −6.30 to −3.72, P<0.001). Indirect comparisons of the different physiotherapy interventions found no evidence that the treatment effect differed across the interventions for any outcomes assessed, apart from motor subscores on the unified Parkinson’s disease rating scale (in which one trial was found to be the cause of the heterogeneity). Conclusions Physiotherapy has short term benefits in Parkinson’s disease. A wide range of physiotherapy techniques are currently used to treat Parkinson’s disease, with little difference in treatment effects. Large, well designed, randomised controlled trials with improved methodology and reporting are needed to assess the efficacy and cost effectiveness of physiotherapy for treating Parkinson’s disease in the longer term.</abstract><relatedItem type="host"><titleInfo><title>BMJ : British Medical Journal</title></titleInfo><titleInfo type="abbreviated"><title>BMJ</title></titleInfo><genre type="Journal">journal</genre><identifier type="eISSN">1756-1833</identifier><identifier type="PublisherID">bmj</identifier><identifier type="PublisherID-hwp">bmj</identifier><identifier type="PublisherID-nlm-ta">BMJ</identifier><part><date>2012</date><detail type="volume"><caption>vol.</caption><number>345</number></detail></part></relatedItem><identifier type="istex">76F28FD69674A9085206DEA896CE201F5FDB97DD</identifier><identifier type="DOI">10.1136/bmj.e5004</identifier><identifier type="href">bmj-345-bmj-e5004.pdf</identifier><identifier type="ArticleID">tomc002253</identifier><identifier type="local">bmj;345/aug06_1/e5004</identifier><accessCondition type="use and reproduction" contentType="open-access">This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. 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