New Physiotherapy Interventions in Parkinson's Disease - What is the Evidence?

Introduction: In the last decade, an increasing number of randomized-controlled trials dealing with innovative new physiotherapeutic approaches for the treatment of Parkinson's disease have been published. Recent meta-analyses reflect this development by providing a much broader basis to evaluate their clinical effects. However, some discrepancies exist between these reports when regarding the selection of clinical trials and the estimation of therapeutic effects. The purpose of this review is to present an updated compilation of available evidence for beneficial effects of the different therapies and their clinical application. Methods: An electronic search was performed in the databases Medline, PubMed, and Google Scholar for meta-analyses, published between January 2000 and March 2014. Results: 8 meta-analyses could be identified. Level Ia evidence can be found for the efficacy of exercise, dance and cueing therapy. Also treadmill training reached level Ia evidence, -although there are some discrepancies between 2 meta-analyses with different criteria for study selection. Tai Chi/-Qigong and LSTV-BIG therapy reached Ib level, positive effects of a repetitive training of compensatory steps could be demonstrated on IIb level. No long lasting effect could be ascertained for whole-body vibration therapy. Positive effects of conventional physiotherapy on flexibility, and motor-and ADL functions are reported in only 3 studies. Effects sizes were always low to moderate, reaching up to 0.56. Almost all patients tested were in less advanced stages of their disease (i. e., Hoehn Yahr 2-3). General problems for an evaluation are a variable content, intensity and duration of tested treatments, as well as control groups with and without any therapy. Conclusion: The new physiotherapeutic concepts offer a promising new approach for treating symptoms of Parkinson's disease. Best effects can be expected in the treatment of bradykinesia and postural instability, so that the tested methods can be considered as a complementary approach to treat symptoms not sufficiently ameliorated by drug therapy or surgical intervention. Considering all published studies, a "best practice" - concept is not yet available.