Physiotherapy in Parkinson's Disease: A Meta-Analysis of Present Treatment Modalities.

The meta-analysis compared different physiotherapy modalities indirectly, not head-to-head, so it cannot show which modality is best. Included trials varied widely in exercise frequency, intensity, duration, and control condition, so pooled effects may not match a specific clinic programme. Only 132 trials reported the randomization method, and information on concealment of treatment allocation was reported in 57 trials, so bias in many trials could not be fully checked. Most trials had small samples and short follow-up, and the analysis used only immediate post-intervention data, so longer-term effects were not assessed. Some commonly discussed techniques, including whole body vibration, massage, boxing, yoga, and fall prevention programmes, had too little data for meta-analysis. Adverse events were not taken into account.

The authors declared no potential conflicts of interest. Professor Bas Bloem was supported by a research grant from the Parkinson's Foundation. Danique Radder, Nienke de Vries, and Ana Lígia Silva de Lima were supported by a research grant from ZonMw. The European Physiotherapy Guideline was mainly financed by ParkinsonNet and the Royal Dutch Society for Physical Therapy.

Do not conclude that all physiotherapy modalities are equivalent or that any exercise programme will improve every Parkinson's symptom. The effects were indirect comparisons, many trials were small and short, and some interventions such as dual task training showed no clear benefit.