Improving the clinical effectiveness of physiotherapy in Parkinson’s disease

Abstract

Parkinson’s disease (PD) is a chronic progressive neurodegenerative condition experienced by 120,000 people in the UK and costing £3.3 billion per annum. Treatment for PD predominantly centres on pharmacological therapy, but patients still experience functional deterioration which has led to a multidisciplinary approach to care. Physiotherapy for PD aims to address impairments in function and activity, but the evidence base is still incomplete.
This thesis identifies current attitudes and practices and describes the influence of research. The first two studies utilise a modified Delphi survey technique and questionnaire to assess current and perceived best practice and outcome measurement for physiotherapy in PD. Study One revealed that therapy is predominantly delivered in a patient’s home, with the majority of referrals coming from a PD Nurse. Study Two highlighted the support for outcome measures, and a discrepancy between expert generated guidelines and perceived achievable best practice by physiotherapists. Study Three was a randomised controlled trial of supported community exercise. The feasibility and acceptability of the intervention was supported, particularly in its high uptake.
Co-operation between researchers and physiotherapists is required to enhance the delivery of best practice. Furthermore, continued methodologically-sound research is needed to underpin physiotherapy for PD.