Physiotherapy in Parkinson's disease. towards evidence-based practice.

Keus, S.H.J. (2010)

Doctoral Thesis

In many countries physiotherapy is often prescribed to PD patients, somewhere in the course of the disease. However, information about the use and efficacy of physiotherapy in PD is sparse, often lacking. Therefore, the aims of this thesis are: (a) to gain better insight into the use and merits of physiotherapy for patients with PD and (b) to take a step forward in obtaining evidence-based physiotherapy for patients with PD. As a first step in this process, the efficacy of physiotherapy in PD was evaluated by means of a systematic review (Chapter 2). Secondly, the quality and quantity of current physiotherapy care in PD was evaluated by means of questionnaires sent to patients with PD and their physiotherapists (Chapter 3). Given the frequent use of physiotherapy and the lack of PD-specific expertise amongst therapists, an evidence-based guideline with practice recommendations was developed (Chapter 4). Next, we wished to examine how effective __best practice__ physiotherapy (as described in this new guideline) is for patients with PD. According to EBM recommendations, the results of an RCT provide the highest level of evidence. Therefore, we designed an RCT. To assess the feasibility of this RCT, we first performed a pilot RCT (Chapter 5). The goals of this pilot study were to examine the recruitment rate of patients, to determine the feasibility of the proposed outcome measures, to evaluate the new guideline as a tool to standardise the intervention within the experimental group and to estimate the effect size of the intervention in order to adequately power the RCT. Based on the results of this feasibility study, steps were taken to optimise two promising outcome measures: the Parkinson Activity Scale, evaluating limitations in ADL, and the Patient Specific Index, a patient preference outcome scale (Chapters 6 and 7). At the same time, the ParkinsonNet concept was developed as a novel approach to further improve the quality of physiotherapy in PD ParkinsonNet aims to improve PD-specific expertise among allied health professionals, to improve the referrals to physiotherapy by neurologists and to enhance communication between allied health professionals and neurologists. We then designed a trial to evaluate the implementation process this new ParkinsonNet concept, as well as the possible health benefits and associated costs (Chapter 8). Finally, an overview of the evolution of physiotherapy in PD was made (Chapter 9), which are presented with future challenges (Chapter 10).

• Evidence-based practice
• Exercise
• Guidelines
• Implementation
• Parkinson's disease
• Physical therapy

• All authors: Keus, S.H.J.
• Supervisor: Roos, R.A.C.; Bloem, B.R.
• Co-supervisor: Munneke, M.
• Qualification: Doctor (dr.)
• Awarding Institution: Leiden University Medical Center (LUMC), Leiden University
• Date: 2010-04-29
• ISBN (print): 9789090252360
• Sponsorship: Parkinson Vereniging, Koninklijk Nederlands Genootschap voor Fysiotherapie (KNGF), Vereniging van Oefentherapeuten Cesar & Mensendieck (VvOCM), Van Alkemade-Keuls Fonds, Boehringer Ingelheim B.V., J. E. Jurriaanse Stichting, Stichting het Remmert Adriaan Laan Fonds, Villerius Medical, GlaxoSmithKline, Novartis Pharma B.V., Solvay Pharmaceuticals GmbH and the European Foundation for Health and Exercise (Efox).