primary outcome:
Physiotherapy for Parkinson's disease: a comparison of techniques
1. Gait outcomes such as:a. two‐ or six‐minute walk test (m), measures the number of metres a person can walk in two or six minutes thereby providing a measurement of walking endurance (Kersten 2004);b. walking speed:i. 10‐ or 20‐metre walk test (s), measures the time in seconds that a person takes to walk 10 or 20 metres thereby providing a measurement of gait speed (Kersten 2004),ii. velocity (m/s), measures the rate of change of position, recorded in metres per second (Trew 2005);c. cadence (steps/min), measures the number of steps taken in a given period of time, which is then converted into the number of steps taken per minute (Trew 2005);d. stride length (m), measures the average distance (in metres) between two successive placements of the same foot (Whittle 1996);e. step length (m), measures the average distance (in metres) between successive foot to floor contact with the opposite feet (Trew 2005);f. Freezing of Gait Questionnaire, a validated questionnaire for the assessment of freezing of gait. The questionnaire consists of six items and scores range from 0 to 24, with higher scores corresponding to more severe freezing of gait (Giladi 2000).2. Functional mobility and balance outcomes such as:a. timed up and go (s), measures the time taken in seconds for a person to get up from a chair, walk a certain distance (usually three metres), turn around and walk back to the chair and sit down (Podsiadlo 1991);b. Functional Reach Test (cm), “the maximal distance one can reach forward beyond arm’s length, while maintaining a fixed base of support in the standing position” (Duncan 1990);c. Berg Balance Scale, a validated questionnaire designed to measure functional standing balance of the older adult. The measure consists of 14 items and score ranges from 0 to 56; with 0 to 20 = high fall risk; 21 to 40 = medium fall risk; and 41 to 56 = low fall risk (Berg 1992; Qutubuddin 2005);d. Activity Specific Balance Confidence. a 16‐item self‐report questionnaire that asks individuals to rate their confidence that they will maintain their balance in the course of daily activities. Each item is rated from 0% (no confidence) to 100% (complete confidence) (Powell 1995; Talley 2008).3. Data on falls such as:a. number of patients falling, e.g. falls diary;b. Falls Efficacy Scale, a 10‐item patient‐reported questionnaire that measures how confident a person is at carrying out various ADL. Items are rated from 1 to 10, with higher scores correlating with lower levels of confidence, and a total score of 70 or more indicating that a person has a fear of falling (Tinetti 1990);c. Falls Efficacy Scale International, a 16‐item questionnaire that includes the 10 original items of the standard Falls Efficacy Scale as well as six items regarding higher functioning and social activities. Each item is rated on a scale of 1 to 4, with 1 being ‘not concerned at all’ and 4 being ‘very concerned’ (maximum score out of 64) (Yardley 2005).4. Clinician‐rated impairment and disability measures such as:a. Hoehn and Yahr, a scale used to describe how symptoms of Parkinson's disease progress. Scale ranges from 0 to 5, with higher levels indicating greater disability (Hoehn 1967);b. Unified Parkinson's Disease Rating Scale (UPDRS), designed to assess motor impairment and disability in Parkinson’s disease. Higher scores correspond to greater disability (Fahn 1987):i. total, score ranges from 0 to 176,ii. mental, score ranges from 0 to 16,iii. ADL, score ranges from 0 to 52,iv. motor, score ranges from 0 to 108;c. Webster Rating Scale, an assessment of severity of disease and clinical impairment against 10 items using a scale of 0 = normal to 3 = maximum impairment (bradykinesia, rigidity, posture, upper extremity swing, gait, tremor at rest, facies, seborrhoea, speech, and self care). Scores ranges from 0 to 30, with higher scores indicating greater disease severity and disability (Webster 1968);d. Columbia University Rating Scale, an assessment of motor impairment and ADL against 13 items, using a five‐point scale for each to give a total score between 0 = normal to 65 = maximum disability (Yahr 1969).5. Patient‐rated quality of life such as:a. Parkinson's Disease Questionnaire‐39 (PDQ‐39), a PD specific health‐related quality of life questionnaire containing 39 items divided into eight domains. Scores range from 0 to 100 with higher scores corresponding to poorer quality of life (Jenkinson 1997; Peto 1995);b. PDQUALIF, a PD specific health‐related quality of life questionnaire containing 32 items in seven dimensions and one item of global health‐related quality of life. The total score ranges from 0 to 128 with higher scores indicating poorer quality of life (Welsh 2003);c. PDQL, a PD specific health‐related quality of life questionnaire containing 37 items grouped into four subscales. Item scores range from 1 to 5. The PDQL‐Summary Index ranges from 37 to 185, with higher scores reflecting better quality of life (Deboer 1996);d. Short Form‐36 (SF‐36) or 12 (SF‐12), a generic short form health survey consisting of 36 or 12 questions. The SF‐36 consists of eight scaled scores assessing vitality, physical functioning, bodily pain, general health perceptions, physical role functioning, emotional role functioning, social role functioning and mental health. Scores range from 0 to 100 with higher scores corresponding to better quality of life (Ware 1992).6. Adverse events e.g. fractures, pain.7. Compliance e.g. participant adherence, treatment fidelity.8. Economic analysis.