Rehabilitation improves dyskinesias in Parkinsonian patients: a pilot study comparing two different rehabilitative treatments.
The present study was devised: (a) to test whether an intensive (60 hours in 4 weeks) multidisciplinary rehabilitation treatment (involving physiotherapy, exercises to improve gait and balance using treadmill and stabilometric platform, occupational therapy) for Parkinsonian patients is effective in improving dyskinesia and motor performance compared to a control group undergoing a non-intensive non multidisciplinary rehabilitation treatment (30 hours in 4 weeks involving physiotherapy only); and (b) to verify whether rehabilitation may lead to a reduction in levodopa dosage.


METHODS
Forty Parkinsonian patients suffering from dyskinesias were admitted to study: 20 for an intensive multidisciplinary (Group1) and 20 for a non-intensive non multidisciplinary rehabilitation treatment (Group2). The rating scales used for the clinical evaluation were: Unified Parkinson's Disease Rating Scales (UPDRS) II, III, IV, Parkinson's disease disability scale (PDDS), Abnormal Involuntary Movement Scale (AIMS).


RESULTS
All outcome measurements improved in both groups of patients, but patients Group1 presented better results: UPDRS II was reduced by 33% in Group1 and by 22% in Group2, UPDRS III 29% vs. 22%, UPDRS IV 74% vs. 10%, PDDS 18% vs. 12%, and AIMS 71% vs. 8%. A different behaviour was observed for levodopa dosage at baseline and after treatment: dosage decreased by an average value of 210 mg (p< 0.0001) in Group1 and was virtually unchanged (30 mg reduction, p=0.08) in Group2.


CONCLUSIONS
Our findings suggest that a rehabilitation protocol should be considered as a valid non-invasive therapeutic support for patients who show dyskinesias and that there are better results when the treatment is intensive.
Department of Neurorehabilitation, Scientific Institute of Montescano, S. Maugeri Foundation IRCCS, Montescano, Italy. giuseppe.frazzitta@fsm.it
Giuseppe
G
Frazzitta
Gabriella
G
Bertotti
Micaela
M
Morelli
Giulio
G
Riboldazzi
Elisa
E
Pelosin
Pietro
P
Balbi
Natalia
N
Boveri
Cristoforo
C
Comi
Marinella
M
Turla
Serena
S
Leva
Guido
G
Felicetti
Roberto
R
Maestri
D000978:Antiparkinson Agents / Q000009:adverse effects; D004185:Disability Evaluation; D004409:Dyskinesia, Drug-Induced / Q000209:etiology / Q000534:rehabilitation*; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D007980:Levodopa / Q000009:adverse effects; D008297:Male; D009068:Movement / Q000502:physiology; D010300:Parkinson Disease / Q000150:complications / Q000188:drug therapy; D026741:Physical Therapy Modalities; D010865:Pilot Projects; D016896:Treatment Outcome
D000978:Antiparkinson Agents; D007980:Levodopa