Physical and occupational therapy have long been components of Parkinson disease (PD) treatment. Prior to the advent of levodopa, this was a primary therapeutic modality. What is the current role for physical therapy in PD? Should everyone with PD be referred? Is it cost-effective? What should be the therapeutic goals and program content?
In the United Kingdom, cost-effectiveness is an especially relevant consideration in the context of its single-payer National Health Service. The cost-effectiveness of routine referral of patients with earlier-stage PD for physiotherapy and occupational therapy was addressed in an article in this edition of JAMA Neurology.1 Half of more than 700 patients with PD from across the United Kingdom were randomized to standard practice physiotherapy and occupational therapy (median, 4; hour-long therapy sessions). Compared with the control group, this therapy intervention failed to meaningfully influence the activities of daily living or quality-of-life measures, with follow-up at 3 and up to 15 months. The investigators concluded that, “This evidence does not support the use of low-dose, patient-centered, goal-directed physiotherapy and occupational therapy in patients in the early stages of PD.”1 The authors cited prior studies that tended to support this conclusion.