Effectiveness of Physiotherapy Interventions for Patients With Parkinson's Disease

Study Overview
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Brief Summary
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Parkinson's Disease is an incurable and progressive disease. Treatment includes medication and non-pharmacological intervention such as physiotherapy. Physiotherapy is a main component of non-pharmacological interventions. It includes exercise to strengthen the muscles; improves balance and walking, and adopts the use of visual cue training. Treatment has been found to be effective in patients with mild impairment up to 6 months post-treatment. The present study will investigate the effectiveness of treatment for patients with mild to moderate impairment for short term (3-month) and long term (1 year). The hypothesis is that compared to patient education alone, physiotherapy intervention for patients with Parkinson's disease leads to improve function and quality of life.

Detailed Description
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Parkinson's disease (PD) is an incurable and progressive disease (Rubenis 2007). Current management include medical, neuro-surgical and non-pharmacological intervention. Physiotherapy is a major component in non-pharmacological interventions. Effective interventions including visual or auditory cues improves gait (Nieuwboer et al. 2007), exercise is effective in improving balance (Hirsch et al 2003); intense treadmill training improves motor control, quality of life and walking speed so as to sustain improvement in gait speed and motor control post 4 weeks of treatment (Herman et al 2007). Patient with PD attending physiotherapy twice weekly, one and half hour for 12 weeks showed improvement in walking speed and Activities of Daily Living (Ellis et al 2005). However, the majority of focus on patients in the Hoehn and Yahr stage of 2 to 3 and long term effect is lacking (Kwakkel et al 2007). A knowledge gap is present in the effectiveness of physiotherapy training of patients with Parkinson's disease in the more advanced stage of disease and long term effect is lacking. The aim of the study is to investigate the immediate, short-term & long-term clinical effects of physiotherapy training of patients with Parkinson's disease. The hypothesis is that compared to patient education alone, physiotherapy intervention for patients with Parkinson's disease leads to improve function and quality of life.

Official Title
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The Effectiveness of Physiotherapy Interventions in Patients With Parkinson's Disease, a Randomized Controlled Trial

Conditions
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Parkinson Disease

Intervention / Treatment
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* Other: Physiotherapy Interventions
* Other: Education Classes


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Stable medication usage Hoehn and Yahr stage II to IV At least 1 score of 2 or more for at least 1 limb of either the tremor, rigidity, or bradykinesia item of the Unified Parkinson's Disease Rating Scale (UPDRS) Able to walk independently No severe cognitive impairments (Mini-Mental State Examination - Chinese Cantonese version) score greater than 24 Exclusion Criteria: Other severe neurological, cardiopulmonary, or orthopedic disorders Having participated in a physiotherapy or rehabilitation program in previous 2 months

Ages Eligible for Study
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Minimum Age: 35 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Physiotherapy Interventions<br>Physiotherapy Interventions including strengthening exercise, balance training, gait training with visual cue, gait training with treadmill. | Other: Physiotherapy Interventions<br>* Physiotherapy interventions including strengthening exercise, balance training, gait training with visual cus and gait training with treadmill<br>|
| Other: Education<br>Education | Other: Education Classes<br>* Education Classes<br>* Other names: Education;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Movement Disorder Society-Unified Parkinson's Disease Rating Scale |  | Baseline. Immediate, 3-month, 6-month and 1 year Post-intervention | 
| Levodopa equivalent daily dosage (LEDD) |  | Baseline. Immediate, 3-month, 6-month and 1 year Post-intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Timed Up and Go Test |  | Baseline. Immediate, 3-month, 6-month and 1 year Post-intervention | 
| Activities-Specific Balance Confidence Scale (Chinese version) |  | Baseline. Immediate, 3-month, 6-month and 1 year Post-intervention | 
| Parkinson's Disease Questionnaire (Standard Chinese Version) | Parkinson's Disease Questionnaire (Standard Chinese Version) - PDQ-39 (Chinese) | Baseline. Immediate, 3-month, 6-month and 1 year Post-intervention | 
| Number of Injurious Falls |  | Baseline. Immediate, 3-month, 6-month and 1 year Post-intervention |