Physiotherapy intervention in Parkinson's disease: systematic review and meta-analysis

Objective To assess the effectiveness of physiotherapy compared with no intervention in patients with Parkinson’s disease. Design Systematic review and meta-analysis of randomised controlled trials. Data sources Literature databases, trial registries, journals, abstract books, and conference proceedings, and reference lists, searched up to the end of January 2012. Review methods Randomised controlled trials comparing physiotherapy with no intervention in patients with Parkinson’s disease were eligible. Two authors independently abstracted data from each trial. Standard meta-analysis methods were used to assess the effectiveness of physiotherapy compared with no intervention. Tests for heterogeneity were used to assess for differences in treatment effect across different physiotherapy interventions used. Outcome measures were gait, functional mobility and balance, falls, clinician rated impairment and disability measures, patient rated quality of life, adverse events, compliance, and economic analysis outcomes. Results 39 trials of 1827 participants met the inclusion criteria, of which 29 trials provided data for the meta-analyses. Significant benefit from physiotherapy was reported for nine of 18 outcomes assessed. Outcomes which may be clinically significant were speed (0.04 m/s, 95% confidence interval 0.02 to 0.06, P<0.001), Berg balance scale (3.71 points, 2.30 to 5.11, P<0.001), and scores on the unified Parkinson’s disease rating scale (total score −6.15 points, −8.57 to −3.73, P<0.001; activities of daily living subscore −1.36, −2.41 to −0.30, P=0.01; motor subscore −5.01, −6.30 to −3.72, P<0.001). Indirect comparisons of the different physiotherapy interventions found no evidence that the treatment effect differed across the interventions for any outcomes assessed, apart from motor subscores on the unified Parkinson’s disease rating scale (in which one trial was found to be the cause of the heterogeneity). Conclusions Physiotherapy has short term benefits in Parkinson’s disease. A wide range of physiotherapy techniques are currently used to treat Parkinson’s disease, with little difference in treatment effects. Large, well designed, randomised controlled trials with improved methodology and reporting are needed to assess the efficacy and cost effectiveness of physiotherapy for treating Parkinson’s disease in the longer term

Improving the clinical effectiveness of physiotherapy in Parkinson’s disease

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

The endangered Hastings River mouse (Pseudomys oralis) as a disperser of ectomycorrhizal fungi in eastern Australia

Rodents are the most widespread and diverse order of vertebrate mycophagists and are key to the dispersal of mycorrhizal fungi. Rodents consume and subsequently disperse fungi through their feces on every continent except Antarctica. This study examines the fungal taxa consumed by the Hastings River mouse (Pseudomys oralis), an endangered Australian endemic rodent from the family Muridae. We analyzed 251 fecal samples collected over a 19-year period between 1993 and 2012 at sites throughout the distribution of the animal in New South Wales and Queensland. We show that at least 16 genera of mycorrhizal fungi are eaten by this species and that it is therefore playing an important role as a vector of ectomycorrhizal truffle-like fungi in eastern Australia. Similar to the fungal diets of other mammals in eastern Australia, seasonal fungal consumption was greatest in autumn and winter. The dietary diversity of P. oralis also appeared to follow a geographic trend from south to north; samples collected at sites in the southern part of the species’ range had greater diversity than those from sites in the northern part of the range, and overall, diets from southern sites yielded more fungal taxa than did northern sites. This study provides novel insights into the diet of P. oralis and highlights the importance of previously overlooked ecosystem services this species provides through its dispersal of mycorrhizal fungi

Supported community exercise in people with long-term neurological conditions: a phase II randomized controlled trial

OBJECTIVE: Adults with long-term neurological conditions have low levels of participation in physical activities and report many barriers to participation in exercise. This study examines the feasibility and safety of supporting community exercise for people with long-term neurological conditions using a physical activity support system. DESIGN: A phase II randomized controlled trial using computer-generated block randomization, allocation concealment and single blind outcome assessment. SETTING: Oxfordshire and Birmingham community Inclusive Fitness Initiative gyms. SUBJECTS: Patients with a long-term neurological condition. INTERVENTIONS: The intervention group (n = 51) received a 12-week, supported exercise programme. The control group (n = 48) participants received standard care for 12 weeks and were then offered the intervention. MAIN MEASURES: Physical activity, adherence to exercise, measures of mobility, health and well-being. RESULTS: Forty-eight patients (n = 51) completed the intervention, achieving 14 gym attendances (range 0-39) over the 12 weeks. Overall activity did not increase as measured by the Physical Activity Scale for the Elderly (change score mean 14.31; 95% confidence interval (CI) −8.27 to 36.89) and there were no statistically significant changes in body function and health and well-being measures. CONCLUSIONS: People with long-term neurological conditions can safely exercise in community gyms when supported and achieve similar attendance to standard exercise referral schemes, but may reduce other life activities in order to participate at a gym