Effectiveness of Long-Term Physiotherapy in Parkinson's Disease: A Systematic Review and Meta-Analysis

Abstract

Background: Long-term physiotherapy is acknowledged to be crucial to manage motor symptoms for Parkinson's disease (PD) patients, but its effectiveness is not well understood.

Objective: This systematic review and meta-analysis aimed to assess the evidence regarding the effectiveness of long-term physiotherapy to improve motor symptoms and reduce antiparkinsonian medication dose in PD patients.

Methods: Pubmed, Cochrane, PEDro, and CINAHL were searched for randomized controlled trials before August 31, 2020 that investigated the effectiveness of physiotherapy for 6 months or longer on motor symptoms and levodopa-equivalent dose (LED) in PD patients with Hoehn and Yahr stage 1- 3. We performed random effects meta-analyses for long-term physiotherapy versus no/control intervention and estimated standard mean differences with 95% confidence intervals (CIs). Levels of evidence were rated by the Grading of Recommendation Assessment, Development and Evaluation approach.

Results: From 2,940 studies, 10 studies involving 663 PD patients were assessed. Long-term physiotherapy had favorable effects on motor symptoms in off medication state [- 0.65, 95% CI - 1.04 to - 0.26, p = 0.001] and LED [- 0.49, 95% CI - 0.89to - 0.09, p = 0.02]. Subgroup analyses demonstrated favorable effects on motor symptoms in off medication state by aerobic exercise [- 0.42, 95% CI - 0.64 to - 0.20, p < 0.001] and LED by multidisciplinary rehabilitation of primarily physiotherapy [- 1.00, 95% CI - 1.44 to - 0.56, p < 0.001]. Quality of evidence for aerobic exercise and multidisciplinary rehabilitation were low and very low.

Conclusion: This review provided evidence that long-term physiotherapy has beneficial impact on motor symptoms and antiparkinsonian medication dose in PD patients and could motivate implementation of long-term physiotherapy.

Keywords: Parkinson’s disease; Physiotherapy; meta-analysis; motor symptoms; randomized controlled trial; systematic review.

Fig. 1

Flow diagram of reviewing process based on the PRISMA statement.

Fig. 2

Risk of bias summary: Review authors’ judgements about each risk of bias item for each included study. Risk of bias for each domain in each study is represented in green for low risk of bias, red for high risk of bias, and yellow for unclear risk of bias.

Fig. 3

Risk of bias graph: review authors’ judgements about each risk of bias item presented as percentages across all included studies.

Fig. 4

Forest plots of MDS-UPDRS/UPDRS motor score in on medication state for physiotherapy versus no/control intervention. (A) Overall effect of physiotherapy interventions. (B) Subgroup analysis (category of intervention).

Fig. 5

Forest plots of MDS-UPDRS/UPDRS motor score in off medication state for physiotherapy versus no/control intervention. (A) Overall effect of physiotherapy interventions. (B) Subgroup analysis (category of intervention).

Fig. 6

Forest plots of MDS-UPDRS/UPDRS ADL score for physiotherapy versus no/control intervention. (A) Overall effect of physiotherapy interventions. (B) Subgroup analysis (category of intervention).

Fig. 7

Forest plots of Levodopa equivalent dose for physiotherapy versus no/control intervention. (A) Overall effect of physiotherapy interventions. (B) Subgroup analysis (category of intervention).