What is Parkinson’s?
- NICE estimated cost of physiotherapy at £156 per person in first year and £25 annually thereafter.(11)
- The best practice tariff of £672 per incident person is only payable if physiotherapy is offered.(12)
- Targeted exercise programmes versus usual care have been shown to reduce costs by an average of £292.(13)
- Community-based physiotherapists, delivering evidence-based interventions, reduced health care costs by €727 compared to usual care.(14)
Parkinson’s is a progressive neurological condition characterised by motor and non-motor problems. The main changes arise from brain dysfunction through reduced production of chemical messengers particularly the neurotransmitter dopamine.(1)
The three main motor (movement) symptoms are bradykinesia (slowness), rigidity (stiffness) and tremor.(1) Diagnosis is usually based on clinical examination. People with Parkinson’s might present with falling, loss of confidence and independence and reduced quality of life.(1, 2)
Drug therapy and deep brain stimulation can provide partial relief of symptoms but many people require additional support from allied health interventions including physiotherapy, rated as a top priority by respondents to the Membership Survey conducted by Parkinson’s UK.(3)
Physiotherapy involvement is supported by a growing evidence base of high quality research, which is informing best practice guidelines.(2) Short-term patient benefits in a range of physical and quality of life measures have been identified through systematic reviews.(4, 5, 6)
Physiotherapy assessment and management focuses on improving physical capacity and quality of movement in daily life though walking and transfer training, balance and falls education, and practice of manual activities (e.g. reaching and grasping). Other issues e.g. pain, well-being, respiratory function and support networks may need attention.(2)
The two main areas of Parkinson’s-specific physiotherapy intervention relate to exercise and movement strategy training.(2)
During the earlier stages, physiotherapists emphasise education and self-management encouraging use of leisure and third sector programmes that promote general fitness and inclusion in community activity. Physiotherapy-specific exercise can offset the effects of Parkinson’s to minimise deterioration in strength, endurance, flexibility and balance.
As the condition progresses, physiotherapists teach and apply movement strategies to overcome difficulty in generating automatic movement and thought, including developing strategies to compensate for loss of function, using external (auditory, tactile, visual and sensory) or internal (mental rehearsal and visualisation) cues, dual task training, self-instruction and improving attention span.
Epidemiology In the UK:
- 127,000 people diagnosed with Parkinson’s(9) makes it the second most common neurological disorder in the UK.(9) With the population ageing, these numbers will double by 2030(2)
Diagnosis is mainly in the over 55’s, but increasingly seen in younger people
- An estimated 4–20/100,000 people are newly diagnosed each year(10)
- 1/500 people are affected, with prevalence increasing with age; 1.4% over 60 and 4.3% over 85 years(2)
- Incidence is 1.5 times higher in males than females.(2)
Physiotherapy is essential in the multidisciplinary management of people with Parkinson’s. Advice and education offered in the early stages maintains general fitness, minimises deterioration and promotes self-management. In the later stages, physiotherapy can improve gait, balance, transfers, manual activities and reduce the falls risk.
Over a six month period, the introduction of a Derby Parkinson’s multidisciplinary team (MDT) delivered an integrated holistic and seamless service, aiming to enable people with Parkinson’s to remain living in the community and as independently as possible.
They run a national training programme for management in Parkinson’s/Parkinsonism and a consultant-led weekly MDT Parkinson’s clinic.
The specialist physiotherapist provides evidenceinformed assessment and rehabilitation, individually and in groups. A specific measure – Lindop Parkinson’s Assessment Scale (LPAS)(7) was developed to monitor alterations in function and falls risk.
The team has shown that effective MDT interventions for Parkinson’s in-patients can reduce length of stay
by 4 days and improve patient satisfaction.(8)
More resources for GPs:
1. Iansek R, Morris M, editors. Rehabilitation in movement disorders. Cambridge: Cambridge University Press; 2013.
2. Keus S, Domingos J, Rochester L, et al. European physiotherapy guideline for Parkinson’s disease [draft]. s.l.: European Parkinson’s Disease Association; 2013.
3. Parkinson’s Disease Society. Life with Parkinson’s today - room for improvement. London: Parkinson’s Disease Society; 2008.
4. Goodwin V, Richards SH, Taylor R, et al. The effectiveness of exercise interventions for people with parkinson’s disease: a systematic review and meta-analysis. Movement Disorders. 2008;23(5):631-40.
5. Tomlinson CL, Patel S, Meek C, et al. Physiotherapy versus placebo or no intervention in Parkinson’s disease. Cochrane Database Syst Rev. 2013;9:CD002817.
6. Allen NE, Sherrington C, Paul SS, et al. Balance and falls in Parkinson’s disease: a meta-analysis of the effect of exercise and motor training. Movement Disorders. 2011 Aug 1;26(9):1605-15.
7. Pearson MJT, Lindop FA, Mockett SP, et al. Validity and inter-rater reliability of the Lindop Parkinson’s Disease Mobility Assessment: a preliminary study. Physiotherapy. 2009;95(2):126-33.
8. Skelly R, Brown L, Fakis A, et al. Does a specialist unit improve outcomes for hospitalised patients with Parkinson’s disease? A prospective study. 3rd World Parkinson Congress; Montreal: Journal of Parkinson’s Disease; 2013:3;Suppl 1: p 196.
10. MacDonald BK, Cockerell OC, Sander JW, et al. The incidence and lifetime prevalence of neurological disorders in a prospective community-based study in the UK. Brain. 2000 Apr;123 ( Pt 4):665-76.
11. National Institute for Health and Clinical Excellence. Parkinson’s disease: diagnosis and management in primary and secondary care: National cost-impact report. London: National Institute foe Health and Clinical Excellence,; 2006.
12. 2014/15 National Tariff Payment System. Annex 5A. Monitor; December 2013.
13. Fletcher E, Goodwin VA, Richards SH, et al. An exercise intervention to prevent falls in Parkinson’s: an economic evaluation. BMC Health Serv Res. 2012;12:426.
14. Munneke M, Nijkrake MJ, Keus SH, et al. Efficacy of community-based physiotherapy networks for patients with Parkinson’s disease: a cluster-randomised trial. Lancet Neurol. 2010 Jan;9(1):46-54.
The CSP would like to thank Bhanu Ramaswamy Independent Physiotherapy Consultant, Dr Anna Jones, Reader Northumbria University, Fiona Lindop Clinical Specialist Derby Hospitals NHS Foundation Trust and Dr Victoria Goodwin, Senior Research Fellow, University of Exeter Medical School