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Intervention Review

Physiotherapy for Parkinson's disease: a comparison of techniques

  1. Katherine Deane2,
  2. Diana E Jones3,
  3. Caroline Ellis-Hill4,
  4. Carl E Clarke1,*,
  5. E Diane Playford5,
  6. Yoav Ben-Shlomo6

Editorial Group: Cochrane Movement Disorders Group

Published Online: 22 JAN 2001

Assessed as up-to-date: 28 NOV 2000

DOI: 10.1002/14651858.CD002815


How to Cite

Deane K, Jones DE, Ellis-Hill C, Clarke CE, Playford ED, Ben-Shlomo Y. Physiotherapy for Parkinson's disease: a comparison of techniques. Cochrane Database of Systematic Reviews 2001, Issue 1. Art. No.: CD002815. DOI: 10.1002/14651858.CD002815.

Author Information

  1. 1

    City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Department of Neurology, Birmingham, West Midlands, UK

  2. 2

    Newcastle University, Institute of Health & Society, Newcastle-upon-Tyne, UK

  3. 3

    Northumbria University, School of Health, Community and Education Studies, Newcastle upon Tyne, UK

  4. 4

    University of Southampton, Health and Rehabilitation Research Unit, Southampton, UK

  5. 5

    The National Hospital for Neurology and Neurosurgery, Directorate of Musculoskeletal and Rehabilitational Services, London, UK

  6. 6

    Canynge Hall, Dept of Social Medicine, Bristol, UK

*Carl E Clarke, Department of Neurology, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Dudley Road, Birmingham, West Midlands, B18 7QH, UK. c.e.clarke@bham.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 22 JAN 2001

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Despite optimal medical and surgical therapies for Parkinson's disease, patients develop progressive disability. The role of the physiotherapist is to maximise functional ability and minimise secondary complications through movement rehabilitation within a context of education and support for the whole person. What form of physiotherapy is most effective in the treatment of Parkinson's disease remains unclear.

Objectives

1. To compare the efficacy and effectiveness of novel physiotherapy techniques versus 'standard' physiotherapy in patients with Parkinson's disease. Standard physiotherapy is defined as the type of therapy that the physiotherapist would usually use to treat Parkinson's disease.
2. To compare the efficacy and effectiveness of one physiotherapy technique versus a second form of physiotherapy.

Search methods

Relevant trials were identified by electronic searches of MEDLINE, EMBASE, CINAHL, ISI-SCI, AMED, MANTIS, REHABDATA, REHADAT, GEROLIT, Pascal, LILACS, MedCarib, JICST-EPlus, AIM, IMEMR, SIGLE, ISI-ISTP, DISSABS, Conference Papers Index, Aslib Index to Theses, the Cochrane Controlled Trials Register, the CentreWatch Clinical Trials listing service, the metaRegister of Controlled Trials, ClinicalTrials.gov, CRISP, PEDro, NIDRR and NRR; and examination of the reference lists of identified studies and other reviews.

Selection criteria

Only randomised controlled trials (RCT) were included.

Data collection and analysis

Data was abstracted independently by KD and CEH and differences settled by discussion.

Main results

Seven trials were identified with 142 patients. All used small numbers of patients and the method of randomisation and concealment of allocation was poor or not stated in all of the trials. These methodological problems could potentially lead to bias from a number of sources. The methods of physiotherapy varied so widely that the data could not be combined.

Authors' conclusions

Considering the small number of patients examined, the methodological flaws in many of the studies and the possibility of publication bias, there is insufficient evidence to support or refute the efficacy of any given form of physiotherapy over another in Parkinson's disease. Another Cochrane review, Physiotherapy for patients with Parkinson's Disease, found that there was insufficient evidence to support or refute the efficacy of physiotherapy compared to no physiotherapy in Parkinson's disease.

A wide range of physiotherapy approaches were used in these studies and a survey of UK physiotherapists confirmed that they also use an eclectic combination of techniques in the treatment of Parkinson's disease (Plant 1999). Therefore a consensus must be found as to 'best practice' physiotherapy for Parkinson's disease.

The efficacy of 'standard' physiotherapy should be proved first before examining variations in physiotherapy methods. Therefore large well designed randomised controlled trials are needed to judge the effect of physiotherapy in Parkinson's disease. After this large RCTs are needed to demonstrate the most effective form of physiotherapy in Parkinson's disease. Outcome measures with particular relevance to patients, carers, physiotherapists and physicians should be chosen and the patients monitored for at least 6 months to determine the duration of any effect. The trials should be reported according to CONSORT guidelines (CONSORT 1996).

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

In spite of the best medical and surgical treatments for Parkinson's disease, patients develop significant physical problems. Physiotherapists aim to enable people with Parkinson's disease to maintain their maximum level of mobility, activity and independence through the monitoring of their condition and the targeting of the appropriate physical treatment. A range of approaches to movement rehabilitation, which with education and support are employed to maximise functional ability, minimise secondary complications and enhance quality of life over the whole course of the disease.

This review will compare the benefits of one form of physiotherapy versus another for people with Parkinson's disease. Relevant trials were identified by electronic searches of 21 medical literature databases, various registers of clinical trials and an examination of the reference lists of the identified studies and other reviews.

Only randomised controlled trials were included in this review. These were studies where two groups of patients were compared, each group of patients receiving a different form of physiotherapy. The patients were assigned to each of the two groups in a random fashion to reduce the potential for bias. Data from the selected trials were extracted independently by two reviewers and differences settled by discussion.

Seven trials were found comparing two forms of physiotherapy in a total of 142 patients. The quality of the trials' methods was variable with all the studies failing in at least one critical area. The methods and outcome measures varied so much that the results of the individual trials could not be combined.

Considering the small number of patients and the methodological flaws in many of the studies, there is insufficient evidence to support the use of one form of physiotherapy over another for the treatment of Parkinson's disease.

Another Cochrane review that examined the efficacy of physiotherapy versus placebo (sham) therapy (Physiotherapy for patients with Parkinson's Disease) concluded that there was insufficient evidence to support or refute the efficacy of physiotherapy in Parkinson's disease.

The benefits of 'standard' physiotherapy should be proved first before examining variations in physiotherapy methods. Therefore large well designed randomised controlled trials (RCTs) are needed to judge the effect of physiotherapy in Parkinson's disease. After this, large RCTs are needed to demonstrate the most effective form of physiotherapy in Parkinson's disease. The design of the trials should minimise bias and be reported fully using CONSORT guidelines. Outcome measures with particular relevance to patients, their carers, physiotherapists and physicians should be chosen and the patients followed for at least 6 months to determine the duration of any improvement.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

以物理治療幫助巴金森氏病: 比較各種技巧

雖然使用了最好的內外科治療,巴金森氏病的病人還是逐漸失能。物理治療的角色在經由運動復健、教育、全人支持來最大化病人的功能及最小化次發的併發症。什麼樣的治療在巴金森氏病最有效還是未知。

目標

比較新型的物理治療和「標準」物理治療對巴金森氏病人的效果和效益。標準的物理治療指的是物理治療師通常會用來治療巴金森氏病的治療。這篇評論的目標是比較某一種物理治療和另一種的效果及效益。

搜尋策略

相關的試驗是以電子搜尋以下資料庫找出: MEDLINE, EMBASE, CINAHL, ISISCI, AMED, MANTIS, REHABDATA, REHADAT, GEROLIT, Pascal, LILACS, MedCarib, JICSTEPlus, AIM, IMEMR, SIGLE, ISIISTP, DISSABS, Conference Papers Index, Aslib Index to Theses, the Cochrane Controlled Trials Register, the CentreWatch Clinical Trials listing service, the metaRegister of Controlled Trials, ClinicalTrials.gov, CRISP, PEDro, NIDRR and NRR; 並檢驗了所找到研究和評論的參考文獻表。

選擇標準

只包含隨機分配試驗。

資料收集與分析

數據是由KD 和CEH 獨立地取出,差異則由討論解決。

主要結論

共找到7個試驗,包含142位病人。這些試驗所包含的病人數都很少,隨機分配的方法和分配的保密方式有的很不好,有的則根本沒有交代。這些方法的問題可能導致許多方面來的誤差。物理治療的方式差異大到數據沒有辦法合併計算。

作者結論

考量到所檢驗的病人數目很少,許多實驗有方法學的缺陷,還有可能的選擇性發表誤差,我們沒有足夠的證據支持或否定一個巴金森氏病的治療法是不是比另一種好。另一篇考科藍評論「以物理治療幫助巴金森氏病人」發現沒有辦法支持或否定物理治療是否比不治療來得好。這些研究中使用了很多種方法,而且一個針對英國的物理治療師的調查也確認他們在治療巴金森氏病時也選擇性地同時使用好幾種方法。因些必須對什麼是「最好的」巴金森氏病物理治療方法形成共識,必須先證實「標準」的物理治療是不是有效,再談到檢驗物理治療的各種形式。因此需要大型的隨機分配試驗來評估物理治療對巴金森氏病的有效性,再以大型的RCT來檢驗哪個物理治療最有效。必須選擇和病人、照顧者、物理治療師和醫師有關的結果指標,並且必須追蹤病人至少6個月以決定治療能有效多久。這些試驗必須遵守CONSORT準則來發表。(CONSORT1996)

翻譯人

本摘要由新光醫院葉旭霖翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

雖然使用了最好的內外科治療,巴金森氏病的病人還是逐漸失能。物理治療師的角色在經由觀察病人並決定最適合的物理治療來最大化病人的活動能力和獨立性。很多種包含教育和支持的方法被用來盡量提升病人的功能、盡量減少次發的併發症並在整個病程中增進生活品質。這篇評論比較對巴金森氏病人來說,一種治療是不是比另一種好。相關的試驗以電子搜尋由21種醫學文獻資料庫、各種臨床試驗的登錄系統、及所找到文獻和相關評論的參考文獻表中找出。只有隨機分配試驗收入本評論。其中有研究是以隨機分配方式將病人分組,再比較它們分別接受兩種不同物理治療的結果。數據是由兩個評論者獨立地從選擇的試驗中取出,再以討論來解決不同的地方。共找到7個試驗,包含142位病人,比較了2種物理治療方式。這些試驗的品質參差不齊,而且任何一個至少在一個重要的地方有瑕疵。這些試驗用的方法和所用的結果指標非常不一樣,以致於沒有辦法結合不同試驗的數據來統計。考量到這些試驗所包含的病人數都很少,許多研究有方法學上的錯誤,並沒有足夠的證據來支持用一種物理治療方式不是比另一種好。另一篇考科藍評論檢驗了物理治療和安慰治療的效果(「以物理治療幫助巴金森氏病」),作出了沒有足夠的證據支持或否定物理治療在巴金森氏病的效果。「標準」物理治療的效果必須先被證實,才能檢驗各種物理治療方法的差異。所以需要大型、設計良好的雙盲試驗(RCTs)來評估物理治療在巴金森氏病的有效性。試驗的設計必須儘量減少偏差,必須完全遵照CONSORT準則發表。必須選用和病人、照顧者、物理治療師、醫師相關的治療結果指標,並且追蹤病人至少6個月來決定任何進步能維持多久。