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Clinical effectiveness and cost-effectiveness of physiotherapy and occupational therapy versus no therapy in mild to moderate Parkinson's disease: a large pragmatic randomised controlled trial (PD REHAB)


, : Clinical effectiveness and cost-effectiveness of physiotherapy and occupational therapy versus no therapy in mild to moderate Parkinson's disease: a large pragmatic randomised controlled trial (PD REHAB). Health Technology Assessment 20(63): 1-96

Cochrane reviews of physiotherapy (PT) and occupational therapy (OT) for Parkinson's disease found insufficient evidence of effectiveness, but previous trials were methodologically flawed with small sample size and short-term follow-up. To evaluate the clinical effectiveness and cost-effectiveness of individualised PT and OT in Parkinson's disease. Large pragmatic randomised controlled trial. Thirty-eight neurology and geriatric medicine outpatient clinics in the UK. Seven hundred and sixty-two patients with mild to moderate Parkinson's disease reporting limitations in activities of daily living (ADL). Patients were randomised online to either both PT and OT NHS services (n = 381) or no therapy (n = 381). Therapy incorporated a patient-centred approach with individual assessment and goal setting. The primary outcome was instrumental ADL measured by the patient-completed Nottingham Extended Activities of Daily Living (NEADL) scale at 3 months after randomisation. Secondary outcomes were health-related quality of life [Parkinson's Disease Questionnaire-39 (PDQ-39); European Quality of Life-5 Dimensions (EQ-5D)], adverse events, resource use and carer quality of life (Short Form questionnaire-12 items). Outcomes were assessed before randomisation and at 3, 9 and 15 months after randomisation. Data from 92% of the participants in each group were available at the primary time point of 3 months, but there was no difference in NEADL total score [difference 0.5 points, 95% confidence interval (CI) -0.7 to 1.7; p = 0.4] or PDQ-39 summary index (0.007 points, 95% CI -1.5 to 1.5; p = 1.0) between groups. The EQ-5D quotient was of borderline significance in favour of therapy (-0.03, 95% CI -0.07 to -0.002; p = 0.04). Contact time with therapists was for a median of four visits of 58 minutes each over 8 weeks (mean dose 232 minutes). Repeated measures analysis including all time points showed no difference in NEADL total score, but PDQ-39 summary index (curves diverging at 1.6 points per annum, 95% CI 0.47 to 2.62; p = 0.005) and EQ-5D quotient (0.02, 95% CI 0.00007 to 0.03; p = 0.04) showed significant but small differences in favour of the therapy arm. Cost-effective analysis showed that therapy was associated with a slight but not significant gain in quality-adjusted life-years (0.027, 95% CI -0.010 to 0.065) at a small incremental cost (£164, 95% CI -£141 to £468), resulting in an incremental cost-effectiveness ratio of under £4000 (£3493, 95% -£169,371 to £176,358). There was no difference in adverse events or serious adverse events. NHS PT and OT did not produce immediate or long-term clinically meaningful improvements in ADL or quality of life in patients with mild to moderate Parkinson's disease. This evidence does not support the use of low-dose, patient-centred, goal-directed PT and OT in patients in the early stages of Parkinson's disease. Future research should include the development and testing of more structured and intensive PT and OT programmes in patients with all stages of Parkinson's disease. Current Controlled Trials ISRCTN17452402. This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 63. See the NIHR Journals Library website for further project information. The Birmingham Clinical Trials Unit, University of Birmingham, received support from the UK Department of Health up to March 2012. Catherine Sackley was supported by a NIHR senior investigator award, Collaboration for Leadership in Applied Health Research and Care East of England and West Midlands Strategic Health Authority Clinical Academic Training award.

US$19.90

PMID: 27580669

DOI: 10.3310/hta20630


Other references

Moreno-Cuerda, V.J.; Morales, M.; Tamargo, L.; Rubio, R.; Pulido, F., 2006: Avascular necrosis of the bone in patients with HIV infection: an emergent problem. Since avascular necrosis of the bone was first described in a HIV infected patient in 1990, its incidence has increased, especially in recent years. The hip is most commonly involved and often bilaterally. We report a series of 5 cases of avascula...

Cannon, W.B.; Bright, E.M., 1931: A belated effect of sympathectomy on lactation. Observations on 2 sympa-thectomized dogs and 2 syrnpathectomized cats show that sympathectomy does not interfere with the processes of reproduction in the [female], but that it may disturb lactation, and that in the cat and dog the disturbances ar...

Kruse, F.H., 1927: Medicine: USE and Abuse of Alkaline Waters. California and Western Medicine 26(3): 366-367

Yamanaka, Y.; Sekine, A.; Kato, T.; Yamakawa, H.; Ikeda, S.; Baba, T.; Iwasawa, T.; Okudela, K.; Ogura, T., 2017: Afatinib Therapy for Brain Metastases Aggravated by a Reduction in the Dose of Erlotinib Due to the Development of Hepatotoxicity. We report an 80-year-old woman with EGFR-mutant lung adenocarcinoma with multiple brain metastases (BMs). All lesions including BM showed a successful resolution after initiating daily 150 mg erlotinib. However, a grade 2 bilirubin-increase develo...

Dickerman, R.D.; Lefkowitz, M.; Arinsburg, S.A.; Schneider, S.J., 2005: Chiari malformation and odontoid panus causing craniovertebral stenosis in a child with Crouzon's syndrome. Crouzon's disease is a well-known disorder affecting multiple organ systems, specifically a craniofacial disorder with highly variable penetrance and severity of deformity. Crouzon's patients typically have anomalies of the skull base le...

Anonymous, 1991: Automation of Pingtung by-product factory. Taiwan sugar 38(4): 14-18

Winther P.; Skovborg E.B.; Kristensen V.F.; Wolstrup J.; Holm E.; Lund A., 1983: Different methods for preservation of hay. Nine basic experiments on treatment of moist hay with NH3 and 6 experiments with addition of Add-H (70% aqueous solution of propionic acid half neutralized with NH3-N) were carried out. Hay containing 60-70% dry matter which was covered airtight w...

Kabus, M., 1982: Differentiation of casein and coprecipitates by means of argento-amperometric titration. Agento-amperometric titration of dried acid casein without and with whey proteins gave values of 11.5 and 18 mu mol/g, resp., for cysteine + cystine content, 20-30% of the value by amino acid analysis. Proportion depended on heat treatment of milk...

Kwak TaeSoon; Yeo JunHwan, 2004: Variation of grain quality and grain filling rapidity Milyang 23/Gihobyeo recombinant inbred lines. A study was conducted to investigate the variation of grain quality and rapidity of grain filling of rice Milyang 23/Gihobyeo recombinant inbred lines (RIL). The parameters tested among 164 RILs were protein content, amylose content, fatty acid co...

Silverman, H.S.; Smith, A.L., 1985: Staphylococcal sepsis precipitated by cocaine sniffing. New England Journal of Medicine 312(26): 1706-1706