Download PDF
Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin 2015; 25(01): 11-18
DOI: 10.1055/s-0034-1395653
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Neue physiotherapeutische Behandlungsmethoden beim Morbus Parkinson – was ist gesichert?

New Physiotherapy Interventions in Parkinsonʼs Disease – What is the Evidence?
G. Küther
1   Medizinische Hochschule, Klinik für Rehabilitationsmedizin, Hannover
› Author Affiliations
Further Information

Publication History

eingereicht 21 July 2014

akzeptiert 14 November 2014

Publication Date:
10 February 2015 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Einleitung: Zur physiotherapeutischen Behandlung der Parkinson-Erkrankung wurde im letzten Jahrzehnt eine steigende Zahl randomisiert kontrollierter Studien mit innovativen neuen Ansätzen publiziert. Dies belegen auch aktuelle Metaanalysen, die eine zunehmend breitere Basis für die Bewertung ihrer klinischen Wirkungen bilden. Allerdings weisen diese Analysen einige Unterschiede im Hinblick auf die Studienauswahl sowie die Bewertung der klinischen Effekte auf. Die vorliegende Übersicht hat daher zum Ziel, eine aktualisierte Zusammenfassung der Evidenz der Wirkungen der einzelnen Verfahren und ihrer klinischen Anwendung zu liefern.

Methode: Eine elektronische Suche nach Metaanalysen, die zwischen Januar 2000 und März 2014 erschienen sind, wurde in den Datenbanken MEDLINE, PubMed und Google Scholar durchgeführt.

Ergebnisse: Es konnten 8 Metaanalysen identifiziert werden. Mit Ia Evidenz ist die Wirkung für die Trainings- und Tanztherapie sowie die Behandlung mit externen Reizen (Cues) belegt. Auch die Laufbandtherapie erreichte Ia Niveau, allerdings findet sich eine abweichende Bewertung in 2 Metaanalysen mit unterschiedlichen Auswahlkriterien für die einbezogenen Studien. Die Wirkung von Tai-Chi bzw. Qigong Übungen und der LSVT-BIG-Therapie ist auf Ib Niveau belegt, positive Wirkungen eines repetitiven Trainings von Ausfallschritten werden auf IIb Niveau berichtet. Keine nachhaltigen Wirkungen konnten bei der Ganzkörper-Vibrationstherapie nachgewiesen werden. Nur auf 3 Studien stützen sich Befunde über positive Effekte der konventionellen Physiotherapie in Bezug auf die Flexibilität sowie motorische und ADL Funktionen. Die Effektstärken wurden insgesamt als gering bis moderat mit Werte bis 0,56 eingeschätzt. Nahezu alle behandelten Patienten befanden sich in einem noch wenig fortgeschritten Stadium ihrer Erkrankung (entsprechend Hoehn und Yahr Stufe 2–3). Grundsätzliche Probleme für eine Bewertung waren variable Inhalte, Intensitäten und eine unterschiedliche Dauer der geprüften Behandlungen sowie der Einschluss von Kontrollgruppen mit aber auch ohne eine Therapie.

Schlussfolgerung: Die neuen physiotherapeutischen Konzepte bieten einen vielversprechenden neuen Ansatz für die Behandlung von Parkinson Patienten. Die besten therapeutischen Wirkungen sind bei der Bradykinese und posturalen Instabilität zu erwarten, sodass die geprüften Methoden als komplementäre Therapieformen zur Behandlung von Symptomen anzusehen sind, die nicht ausreichend durch eine medikamentöse oder operative Behandlung zu bessern sind. Anhand der bisher publizierten Studien lässt sich noch kein optimales, einheitliches Physiotherapiekonzept angeben.

Abstract

Introduction: In the last decade, an increasing number of randomized-controlled trials dealing with innovative new physiotherapeutic approaches for the treatment of Parkinson´s disease have been published. Recent meta-analyses reflect this development by providing a much broader basis to evaluate their clinical effects. However, some discrepancies exist between these reports when regarding the selection of clinical trials and the estimation of therapeutic effects. The purpose of this review is to present an updated compilation of available evidence for beneficial effects of the different therapies and their clinical application.

Methods: An electronic search was performed in the databases Medline, PubMed, and Google Scholar for meta-analyses, published between January 2000 and March 2014.

Results: 8 meta-analyses could be identified. Level Ia evidence can be found for the efficacy of exercise, dance and cueing therapy. Also treadmill training reached level Ia evidence, although there are some discrepancies between 2 meta-analyses with different criteria for study selection. Tai Chi/Qigong and LSTV-BIG therapy reached Ib level, positive effects of a repetitive training of compensatory steps could be demonstrated on IIb level. No long lasting effect could be ascertained for whole-body vibration therapy. Positive effects of conventional physiotherapy on flexibility, and motor- and ADL functions are reported in only 3 studies. Effects sizes were always low to moderate, reaching up to 0.56. Almost all patients tested were in less advanced stages of their disease (i. e., Hoehn Yahr 2–3). General problems for an evaluation are a variable content, intensity and duration of tested treatments, as well as control groups with and without any therapy.

Conclusion: The new physiotherapeutic concepts offer a promising new approach for treating symptoms of Parkinsonʼs disease. Best effects can be expected in the treatment of bradykinesia and postural instability, so that the tested methods can be considered as a complementary approach to treat symptoms not sufficiently ameliorated by drug therapy or surgical intervention. Considering all published studies, a “best practice” concept is not yet available.

Schlüsselwörter

Physiotherapie - Parkinson-Erkrankung - Evidenz

Key words

physiotherapy - Parkinsonʼs Disease - evidence
 

  • Literatur

  • 1 Yarrow S. Members’ 1998 survey of the Parkinson’s Disease Society of the United Kingdom. In: Percival R, Hobson P. eds Parkinson’s disease: Studies in psychological and social care. BPS Books; Leicester: 1999: 79-92
    Search in Google Scholar
  • 2 Weaver F, Follett K, Hur K et al. Deep brain stimulation in Parkinson´s disease: a metaanalysis of patient outcomes. J Neurosurg 2005; 103: 956-967
    CrossrefPubMedSearch in Google Scholar
  • 3 Lang AE, Lozano AM. Parkinson´s disease. Part 1 of 2. N Engl J Med 1998; 339: 1044-1053
    CrossrefPubMedSearch in Google Scholar
  • 4 Olanow CW, Stern MB, Sethi K. The scientific and clinical basis for the treatment of Parkinson disease. Neurology 2009; 72: S1-S136
    PubMedSearch in Google Scholar
  • 5 Deane K, Jones DE, Ellis-Hill C et al. Physiotherapy for Parkinsonʼs disease: a comparison of techniques. Cochrane Database of Systematic Reviews 2001; Issue 1. Art No.: CD002815
    PubMedSearch in Google Scholar
  • 6 Tomlinson CI, Patel S, Meek C et al. Physiotherapy versus placebo or no intervention in Parkinson’s disease. Cochrane Database of Systematic Reviews 2013; Issue 9. Art No.: CD002817
    PubMedSearch in Google Scholar
  • 7 de Goede CJ, Keus SH, Kwakkel G et al. The effects of physical therapy in Parkinson´s disease: A research analysis. Arch Phys Med Rehabil 2001; 82: 509-515
    CrossrefPubMedSearch in Google Scholar
  • 8 Goodwin VA, Richards SH, Taylor RS et al. The effectiveness of exercise interventions for people with Parkinson’s disease: a systematic review and meta-analysis. Mov Disord 2008; 23: 631-640
    CrossrefPubMedSearch in Google Scholar
  • 9 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. Mov Disord 2011; 26: 1605-1615
    CrossrefPubMedSearch in Google Scholar
  • 10 Mehrholz J, Friis R, Kugler J et al. Treadmill training for patients with Parkinson’s disease (Review). Cochrane Database of Systematic Reviews 2010; Issue 1. Art No.: CD007830
    PubMedSearch in Google Scholar
  • 11 Rabert MS, Comas DR, Vanmeerhaeghe AF et al. Whole-body vibration training for patients with neurodegenerative disease. Cochrane Database of Systematic Reviews 2012; Issue 2. Art No.: CD009097
    PubMedSearch in Google Scholar
  • 12 de Dreu MJ, van der Wilk AS, Poppe E et al. Rehabilitation, exercise therapy and music in patients with Parkinson’s disease: a meta-analysis of the effects of music-based movement therapy on walking ability, balance and qualitiy of life. Parkinsonism Relat Disord 2012; 18 (Suppl 1) S114-S119
    PubMedSearch in Google Scholar
  • 13 Spaulding SJ, Barber B, Colby M et al. Cueing and gait improvements among people with Parkinson’s disease: a meta-analysis. Arch Phys Med Rehab 2013; 94: 562-570
    CrossrefPubMedSearch in Google Scholar
  • 14 Kersten P. Principles of physiotherapy assessment and outcome measures. In: Stokes M. (ed.). Physical Management in Neurological Rehabilitation. 2nd Edition Elsevier Mosby; London: 2004: 29-46
    CrossrefSearch in Google Scholar
  • 15 Trew M, Everett T. Human Movement: An Introductory Text. 5th Edition Churchill Livingstone; Edinburgh: 2005
    Search in Google Scholar
  • 16 Whittle M. Gait analysis: an introduction. 2nd Edition , Butterworth-Heinemann; Oxford: 1996
    Search in Google Scholar
  • 17 Podsiadlo D, Richardson S. The Timed Up and Go – a test of basic functional mobility for frail elderly persons. J Am Ger Soc 1991; 39: 142-148
    CrossrefPubMedSearch in Google Scholar
  • 18 Giladi N, Shabtai H, Simon ES et al. Construction of freezing of gait questionnaire for patients with Parkinsonism. Parkinsonism & Related Disorders 2000; 6: 165-170
    CrossrefPubMedSearch in Google Scholar
  • 19 Duncan PW, Weiner DK, Chandler J et al. Functional reach: a new clinical measure of balance. J Geron 1990; 45: M192-M197
    PubMedSearch in Google Scholar
  • 20 Berg KO, Wooddauphinee SL, Williams JI. Measuring balance in the elderly – validation of an instrument. Canad J Pub Health-Rev 1992; 83: S7-S11
    PubMedSearch in Google Scholar
  • 21 Tinetti ME, Richman D, Powell L. Falls efficacy as a measure of fear of falling. J Geront 1990; 45: 239-243
    CrossrefPubMedSearch in Google Scholar
  • 22 Fahn S, Elton RL. UPDRS Development Committee. Unified Parkinson’s Disease Rating Scale. In: Fahn S, Marsden CD, Calne DB, Goldestein M. (eds.). Recent Developments in Parkinson’s Disease. Macmillan Health Care Information; Florham Park: 1987: 153-163
    Search in Google Scholar
  • 23 Jenkinson C, Fitzpatrick R, Peto V et al. The Parkinson’s Disease Questionnaire (PDQ-39): development and validation of a Parkinson’s disease summary index score. Age and Ageing 1997; 26: 353-357
    CrossrefPubMedSearch in Google Scholar
  • 24 Peto V, Jenkinson C, Fitzpatrick R et al. The development and validation of a short measure of functioning and well-being for individuals with Parkinson´s disease. Quality of Life Research 1995; 4: 241-248
    CrossrefPubMedSearch in Google Scholar
  • 25 Deboer AGEM, Wijker W, Speelman JD et al. Quality of life in patients with Parkinson’s disease: development of a questionnaire. J Neurol Neurosurg Psych 1996; 61: 70-74
    CrossrefPubMedSearch in Google Scholar
  • 26 Ware JE, Sherbourne CD. The Mos 36-Item Short-Form Health Survey (SF-36).1. Conceptual-framework and item selection. Med Care 1992; 30: 473-483
    CrossrefPubMedSearch in Google Scholar
  • 27 Hoehn MM, Yahr MD. Parkinsonism – onset, progression, and mortality. Neurology 1967; 17: 427-442
    CrossrefPubMedSearch in Google Scholar
  • 28 Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions. Wiley; Chichester: 2008
    CrossrefSearch in Google Scholar
  • 29 Eccles M, Mason J. How to develop cost-conscious guidelines. Health Technol Assess 2001; 5: 1-69
    PubMedSearch in Google Scholar
  • 30 Comella CL, Stebbins GT, Brown-Toms N et al. Physical therapy and Parkinson´s disease: a controlled clinical trial. Neurology 1994; 44: 376-378
    CrossrefPubMedSearch in Google Scholar
  • 31 Fisher BE, Wu AD, Salem GJ et al. The effect of exercise training in improving motor performance and corticomotor excitability in people with early Parkinson´s disease. Arch Phys Med Rehab 2008; 89: 1221-1229
    CrossrefPubMedSearch in Google Scholar
  • 32 Ashburn A, Fazakarley L, Ballinger C et al. A randomized controlled trial of a home based excise programme to reduce the risk of falling among people with Parkinson´s disease. J Neurolog Neurosurg Psych 2007; 78: 678-684
    PubMedSearch in Google Scholar
  • 33 Schenkman M, Cutson TM, Kuchibhatla M et al. Exercise to improve spinal flexibility and function for people with Parkinson´s disease: a randomized, controlled trial. J Am Ger Soc 1998; 46: 1207-1216
    CrossrefPubMedSearch in Google Scholar
  • 34 Frazzitta G, Balbi P, Maestri R et al. The beneficial role of intensive exercise on Parkinson´s disease progression. Am J Phys Med Rehabil 2013; 92: 523-532
    CrossrefPubMedSearch in Google Scholar
  • 35 Van der Kolk NM, King LA. Effects of exercise on mobility in people with Parkinson´s disease. Mov Disord 2013; 28: 1587-1596
    CrossrefPubMedSearch in Google Scholar
  • 36 Frazzitta G, Bertotti G, Riboldazzi G et al. Effectiveness of intensive inpatient rehabilitation treatment on disease progression in parkinsonian patients: a randomized controlled trial with 1-year follow-up. Neurorehabil Neural Repair 2012; 26: 144-150
    CrossrefPubMedSearch in Google Scholar
  • 37 Toole T, Hirsch MA, Forkink A et al. The effects of a balance and strength training program on equilibrium in Parkinsonism: a preliminary study. Neurorehabilitation 2000; 14: 165-174
    PubMedSearch in Google Scholar
  • 38 Hirsch MA, Toole T, Maitland CG et al. The effects of balance training and high intensity resistance training on persons with idiopathic Parkinson´s disease. Arch Phys Med Rehabil 2003; 84: 1109-1117
    CrossrefPubMedSearch in Google Scholar
  • 39 Ellis T, de Goede CJ, Feldman RG et al. Efficacy of a physical therapy program in patients with Parkinson’s disease: a randomized controlled trial. Arch Phys Med Rehabil 2005; 86: 626-632
    CrossrefPubMedSearch in Google Scholar
  • 40 Bosco C, Cardinale M, Tsarpela O et al. The influence of whole body vibration on jumping performance. Biol Sport 1998; 15: 157-164
    PubMedSearch in Google Scholar
  • 41 Mikhael M, Orr R, Fiatarone Singh MA. The effect of whole body vibration exposure on muscle or bone morphology and function in older adults: a systematic review of the literature. Maturitas 2010; 66: 150-157
    CrossrefPubMedSearch in Google Scholar
  • 42 Merriman H, Jackson K. The effects of whole-body vibration training in aging adults: a systematic review. J Ger Phys Ther 2009; 32: 134-145
    PubMedSearch in Google Scholar
  • 43 Arias P, Chouza M, Vivas J et al. Effect of whole body vibration in Parkinson´s disease: a controlled study. Mov Disord 2009; 24: 891-898
    CrossrefPubMedSearch in Google Scholar
  • 44 Chouza M, Arias P, Vinas S et al. Acute effects of whole-body vibration at 5, 6, and 9 Hz on balance and gait in patients with Parkinsonʼs disease. Mov Disord 2011; 26: 920-921
    CrossrefPubMedSearch in Google Scholar
  • 45 Haas CT, Turbanski S, Kessler K et al. The effects of random whole-body vibration on motor symptoms in Parkinson´s disease. NeuroRehab 2006; 21: 29-36
    PubMedSearch in Google Scholar
  • 46 Ebersbach G, Edler D, Kaufhold O et al. Whole body vibration versus conventional physiotherapy to improve balance and gait in Parkinson´s disease. Arch Phys Med Rehabil 2008; 89: 399-403
    CrossrefPubMedSearch in Google Scholar
  • 47 Martin JP. Locomotion and the basal ganglia. The basal ganglia and posture. Pitman Publishing; London: 1967
    Search in Google Scholar
  • 48 Rubinstein T, Giladi N, Hausdorff JM. The power of cueing to circumvent dopamine deficits: a review of physical therapy treatment of gait disturbances in Parkinson´s disease. Mov Disord 2002; 17: 1148-1160
    CrossrefPubMedSearch in Google Scholar
  • 49 Ramig L, Mead C, Scherer R et al. Voice treatment for patients with Parkinsonsʼs disease: development of an approach and preliminary efficacy data. J Med Speech Lang Path 1994; 2: 191-209
    PubMedSearch in Google Scholar
  • 50 Jöbkes M, Heuschkel G, Pretzel C et al. Repetitive training of compensatory steps: a therapeutic approach for postural instability in Parkinson’s disease. J Neurol Neurosurg Psychiatry 2004; 75: 1682-1687
    CrossrefPubMedSearch in Google Scholar
  • 51 Ebersbach G, Ebersbach A, Edler D et al. Comparing exercise in Parkinson’s disease – the Berlin LSVT®BIG study. Mov Disord 2010; 25: 1902-1908
    CrossrefPubMedSearch in Google Scholar
  • 52 Duncan RP, Earhart GM. Randomized controlled trial of community-based dancing to modify disease progression in Parkinson disease. Neurorehab Neur Repair 2012; 26: 132-143
    PubMedSearch in Google Scholar
  • 53 Hackney ME, Earhart GM. Effects of dance on movement control in Parkinson´s disease: a comparison of Argentine tango and American ballroom. J Rehab Med 2009; 41: 475-481
    CrossrefPubMedSearch in Google Scholar
  • 54 Lee MS, Lam P, Ernst E. Effectiveness of Tai Chi for Parkinsonʼs disease: a critical review. Parkinsonism Relat Disord 2008; 14: 589-594
    CrossrefPubMedSearch in Google Scholar
  • 55 Hackney ME, Earhart GM. Tai Chi improves balance and mobility in people with Parkinsonʼs disease. Gait Posture 2008; 28: 456-460
    CrossrefPubMedSearch in Google Scholar
  • 56 Marjama-Jyons J, Smith L, Mylar B et al. Tai Chi and reduced rate of falling in Parkinson´s disease: a single-blinded pilot study. Mov Disord 2002; 17: 190
    PubMedSearch in Google Scholar
  • 57 Purchas MA, MacMahon DG. The effects of Tai Chi training on general wellbeing and motor performance in patients with Parkinsonʼs disease (PD): a pilot study. Mov Disord 2007; 22: 260
    PubMedSearch in Google Scholar
  • 58 Schmitz-Hubsch T, Pyfer T, Kielwein K et al. Qigong exercise for the symptoms of Parkinsonʼs disease: a randomized, controlled pilot study. Mov Disord 2006; 21: 543-548
    CrossrefPubMedSearch in Google Scholar
  • 59 Li F, Harmer P, Fitzgerald K et al. Tai Chi and postural stability in patients with Parkinson´s disease. N Engl J Med 2012; 366: 511-519
    CrossrefPubMedSearch in Google Scholar