Is physical therapy recommended for people with parkinson's disease treated with subthalamic deep brain stimulation? a delphi consensus study.
Matteo Guidetti, Sara Marceglia, Tommaso Bocci and 21 others
PMID 40211348WHAT IT FOUND
Experts recommend conventional physical therapy for Parkinson's patients with deep brain stimulation, but the underlying evidence is weak.
No randomized trials exist, so this is expert opinion, not proof of effectiveness. Do not treat it as a clinical guideline.
Key findings
01A systematic review found no randomized controlled trials on physical therapy for Parkinson's patients with deep brain stimulation, only 12 small, low-quality studies.
02The Delphi panel reached consensus that physical therapy might improve motor symptoms and quality of life, and should be part of multidisciplinary care, but this is based on expert agreement rather than trial data.
03Experts agreed conventional active exercise (gait, balance, transfers) should be prescribed, but discouraged massage/manual therapy and robot-assisted gait training due to lack of evidence.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The systematic review found zero randomized controlled trials, meaning there is no high-quality evidence to support any claims of efficacy. The included studies were small (1 to 73 patients) and had poor methodological quality, with many failing to report key details like dropout rates or statistical variability. The Delphi consensus represents expert opinion (Level 4 evidence), which is the lowest level of evidence hierarchy. The expert panel was geographically and demographically limited (mostly male, from North America and Europe), which may bias the recommendations. The study focused only on STN-DBS, so findings may not apply to patients with other DBS targets like GPi.
Declared interests
The authors state that the panel conclusions are based on collective expertise and scientific knowledge. No specific funding sources or conflicts of interest are detailed in the provided text, but the reliance on expert opinion rather than new trial data is a methodological limitation.
The easy way to misread this
Do not interpret the experts' agreement that PT 'might help' as proof that it 'works'. The underlying evidence is from small, low-quality studies with no randomized trials, so this is a recommendation for research and clinical practice based on plausibility and safety, not demonstrated efficacy.