Rehabilitation for Parkinson's disease: a systematic review of available evidence.
OBJECTIVE
To systematically review the available evidence on the effectiveness of nonpharmacological rehabilitation interventions for people with Parkinson's disease, and identify future research needs.


METHODS
Electronic searches of four databases (CINAHL, Cochrane Library, MEDLINE, PsychLIT) 1980-2002; examination of reference lists of relevant papers. Controlled trials and observational studies were included. Data extraction and quality assessment of papers by two independent reviewers. A narrative review.


METHODS
Rehabilitation interventions delivered either in subjects' own homes, or in clinical settings as outpatients.


METHODS
Community-living adults with Parkinson's disease.


METHODS
Physiotherapy, occupational therapy, speech and language therapy, psychological counselling and support, and education.


METHODS
A range of outcomes: mobility, functional status, speech, swallowing, psychological well-being, as determined by the studies included in the review.


RESULTS
Forty-four different studies (reported in 51 papers) were included (25 physiotherapy, 4 occupational therapy, 10 speech and language therapy, 3 psychological counselling, 1 educational, 1 multidisciplinary). All studies, except one, reported improvements on at least one outcome measure.


CONCLUSIONS
Findings may reflect publication bias, but suggest interventions can affect patients' lives for the better in a variety of ways. It is difficult to interpret the clinical importance of statistically significant improvements reported in most studies. There is a need for methodologically more robust research with meaningful follow-up periods, designed in a manner that separates specific and nonspecific effects. Cost-effectiveness evidence is required to provide clear guidance on service extensions.
Gage
Heather
H
Department of Economics, University of Surrey, Guildford, Surrey GU2 7XH, UK. H.Gage@surrey.ac.uk
Storey
Lesley
L
D006801:Humans; D007808:Language Therapy; D009788:Occupational Therapy; D017063:Outcome Assessment, Health Care; D010300:Parkinson Disease / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D013070:Speech Therapy