Structured guideline-based physiotherapy reduces difficulties in activities of daily living in Parkinson's disease.

Only 24 people took part, all from one hospital in Estonia, so these results may not hold in a larger or different group of patients. The physiotherapy group reported considerably more difficulty with daily activities at the start than the control group (total score 48.71 versus 30.84), even though the difference was reported as not statistically significant. A group that starts worse has more room to improve, so part of the change may be this rather than the treatment. The ModPSFS, the measure the whole result rests on, was new and had not been tested for validity or reliability. The authors say they hope this will be provided in the near future. Nobody was described as blinded, and the same researcher interviewed each patient at both assessments, so both the patients and the assessor knew who had received treatment. The people recruited were relatively well functioning: they could all walk indoors without an aid, had no other conditions affecting walking or balance, and had not had physiotherapy in the previous year. That is not the full range of patients you see with Parkinson's disease. The physiotherapy was delivered in groups of three rather than one to one, which the authors say may have influenced the results. The authors suggest that a 10-minute section of manual activities in each session may have helped arm function and so reduced difficulty with daily tasks, but arm function was not measured in this paper, so this is their reasoning and not a finding. Endurance and exercise tolerance were deliberately not worked on much during supervised sessions, so this trial says nothing about whether training those would help.

The article text provided does not include a funding statement or a competing interests declaration, so it is not possible to say from this paper who paid for the work or what the authors declared.

Do not read this as proof that guideline-based group physiotherapy works for Parkinson's disease. Only 24 people took part, the physiotherapy group started out reporting far more difficulty with daily activities than the control group (48.71 versus 30.84 points), and the scale used to measure improvement had never been checked for validity or reliability, so the change seen could be partly these problems rather than the treatment.