BUrst vs. Spaced Physical Therapy for Parkinson's Disease: The BUS PT Timing Trial
Condition: Parkinson Disease
MeSH terms: Parkinson Disease
Study type: Interventional

Summary: 
      Many patients with Parkinson's Disease (PD) will encounter difficulties with balance,
      posture, and gait for which physical therapy (PT) has been shown to be beneficial. The
      purpose of this study is to randomize patients between standard "burst" PT versus "spaced" PT
      to inform on the optimal frequency of PT for PD patients. Burst PT in this study was defined
      as 2 PT visits per week for 6 weeks (12 sessions) and spaced PT, as 1 PT visit every other
      week for 6 months (12 sessions).
    

Detailed description: 
      Parkinson's Disease (PD) is a progressive neurodegenerative disorder with a negative impact
      on quality of life.1 Many patients with PD will encounter difficulties with balance, posture,
      transfer, gait and physical capacity due to the motor symptoms of the disease.2 For these
      symptoms, physical therapy (PT) has been shown to be beneficial and clinically useful for the
      motor symptoms and thus is routinely prescribed alongside medical management. However,
      despite increasing evidence of the positive effects of physical therapy for patients with PD,
      there is no standard approach for organizing physiotherapy in the context of
      multidisciplinary care. Administration of physical therapy as a "burst" of frequent sessions
      delivered over 4-6 weeks is the most commonly employed strategy in PD patients and is driven
      largely by the payer system. Burst therapy has been useful in post-stroke and post traumatic
      brain injury rehabilitation, however, the investigators of this study hypothesize that this
      approach will be suboptimal in PD when compared to therapy which is "spaced" over a longer
      period of time. The purpose of this study is to randomize patients between typical "burst" PT
      versus "spaced" PT to inform on the optimal frequency of PT for PD patients. Burst PT in this
      study was defined as 2 PT visits per week for 6 weeks (12 sessions) and spaced PT, as 1 PT
      visit every other week for 6 months (12 sessions).

      30 PD patients were recruited as part of a pilot trial to assess the effectiveness of burst
      vs. spaced physical therapy (the BUS PT trial). Baseline measures were collected on all
      patients, including the timed up and go test (TUG), the baseline frequency of utilization of
      PT, falls, fractures, hospitalizations, the 10 meter walk test (10MWT), the Mini Balance
      Evaluation Systems Test (miniBESTest), objective gait analysis using Gaitrite, the
      Parkinson's Disease Questionnaire-39 (PDQ39), the Unified Parkinson's Disease Rating Scale
      (UPDRS) "ON" and "OFF" motor scores, the quantitation of the levodopa equivalent daily doses
      (LEDD), and the Godin Leisure Activity Questionnaire to assess baseline exercise levels.

      The investigators hypothesized that "spaced" PT is beneficial for maintenance of physical
      function in PD. Prior collective evidence suggests that long-term continuous exercise in PD
      patients is associated with positive outcomes, however a spaced PT approach has not been
      employed. This study will provide useful data that will directly impact payer systems,
      reimbursements and access to care for PD patients.
    

Intervention name(s): Frequency of physical therapy sessions
Intervention type(s): Other
Intervention description(s): Physical therapy sessions consisted of standard of care practice at our center of excellence i two different frequencies. All patients in both groups received 12 physical therapy sessions. Patients in the burst group received 2 physical therapy sessions per week in 6 weeks, while patients in the spaced group received 1 session every 2 weeks for 6 months.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Parkinson's Disease; Physical Therapy; Time Up and Go; Spaced Physical Therapy