Physical Therapist Management of Parkinson Disease: A Clinical Practice Guideline From the American Physical Therapy Association.
Jacqueline A Osborne, Rachel Botkin, Cristina Colon-Semenza and 9 others
PMID 34963139WHAT IT FOUND
Physical therapists should prescribe aerobic, resistance, balance, and gait training early in Parkinson's disease.
External cueing improves walking, and community-based exercise helps motor and non-motor symptoms. Telerehabilitation is a viable option for balance when in-person care is inaccessible.
Key findings
01Strong evidence supports implementing moderate-to-high intensity aerobic exercise, resistance training, balance training, and gait training to reduce motor severity and improve function.
02External cueing is recommended to reduce motor disease severity and freezing of gait, and to improve gait outcomes.
03Telerehabilitation may be used to improve balance, particularly given low referral rates to in-person rehabilitation.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The review only included randomized controlled trials, potentially excluding relevant evidence from other study designs. Most studies included individuals in early to mid-stages of Parkinson disease (Hoehn & Yahr 1-3), so recommendations may not generalize to those with advanced disease or significant cognitive impairment. There was considerable variability in intervention dosing and outcome measures across the included studies, making precise prescription guidelines difficult.
Declared interests
The American Physical Therapy Association funded the work and the methodology consultants. The guideline development group members were declared free of relevant conflicts of interest.
The easy way to misread this
Do not apply these recommendations uniformly to all patients with Parkinson disease. The evidence is strongest for individuals in the early to mid-stages (Hoehn & Yahr 1-3) without significant cognitive impairment; benefits and safety for those in advanced stages or with dementia are not established by this review.